Is Blepharoplasty Covered by Insurance?
Eyelid surgery is one of the most popular cosmetic procedures, along with facelift and liposuction. Patients may want an eyelid lift surgery in New Jersey when they find that the excess skin over the eyes sags and makes them look older. In extreme cases, the skin over the eyes can droop enough to affect your vision.
That’s why patients may wonder “does insurance cover eyelid surgery?” After all, this procedure can cost $2,000 or more, so it’s helpful for your budget if your eyelid surgery is deemed medically necessary, and covered by insurance. It makes financial sense to be curious about blepharoplasty insurance coverage. Below is more information about the possibility of eyelid surgery being covered by insurance.
Functional Eyelid Lift Surgery Overview
An upper eyelid surgery is often done for cosmetic purposes to tighten and trim away fat and tissue on the upper lids to make the patient look younger.
You may be a candidate for eyelid surgery overview if you have these issues:
- Droopy or baggy upper eyelid
- Extra eyelid skin on the upper eyelid that makes it hard to see from the sides
- Excess eyelid skin on the lower eyelids
- Puffy bags below the eyes
An eyelid surgery can take out loose tissue and excess skin from the lower eyelids that give the patient puffy bags below the eyes. You also may opt for related procedures at the same time, such as a brow lift.
Eyelid surgery can be covered by insurance if it is deemed medically necessary by your doctor and medical insurance provider. Functional eyelid surgery takes out the heavy, droopy skin that may hang over the eyelashes and make it hard to see.
If the upper eyelid impairs vision this is not only a cosmetic procedure. Impaired vision from loose upper eyelid skin can make it more challenging to drive, read, and even send text messages.
Proof Required For Health Insurance
Most medical insurance companies require you to provide proof to attempt to qualify for upper eyelid surgery to be covered by insurance:
Doctor’s Notes
The notes from your physician must show the position of your upper eyelids, as well as a decreased field of vision, as well as complaints from the patient about upper lids making it hard to read, see, drive, text, etc.
Your lid position should be measured with oculoplastic measurement methods that show the excess skin or lead is within less than 2 mm of your pupil.
External Photography
These are high-resolution pictures of your eyes and eyelids. For you to meet the criteria, the extra skin and eyelids need to fall within less than 2 mm of the pupil’s center. In addition, your insurance company will want to see clear side and frontal photos.
Visual Fields
Next, your eye doctor will perform a visual field test to check your peripheral vision. This test is usually done by an ophthalmologist.
This test is done with the eyelids in their normal position and held in a higher place with tape. This will help to get a clear measurement of how much excess eyelid skin a patient is dealing with. The difference between the taped and untapped field of vision will dictate if your health insurance company will pay for the plastic surgery.
The field of view test must boost your vision by a specific percentage, depending on the insurance company’s rules.
Once your surgeon has all of this information, they will determine if your upper eyelid surgery is medically necessary. If so, your surgeon will turn in all test results and notes to the insurance company.
Your insurance company can pre-authorize or deny the request. If you get a pre-authorization, it means the insurance company will cover the procedure because it’s medically necessary.
Still, it’s possible that surgery for your sagging eyelids won’t be covered by insurance. The provider may do another review after the procedure is done and decide they won’t pay for it. You can usually file an appeal to get them to cover the procedure if they deny coverage.
Most insurance companies will pay for the procedure once they have given pre-authorization.
Note that insurance companies usually only cover upper eyelid surgery and not surgery for the lower eyelids.
Eyelid Surgery Risks
Eyelid surgery is usually safe and effective for the vast majority of patients. However, any plastic surgery has risks and the possibility of complications. With eyelid surgery, these are the most common issues:
- Bleeding and infection
- Dry eyes
- Eye muscle injuries
- Follow-up surgery needed to correct problems
- Noticeable scarring
- Blurred vision that goes away during recovery
- Adverse reaction to anesthesia
During your consultations before surgery, plastic surgeons will always review your health, pre existing conditions, if any, and the medications you take. Understanding what is involved in eyelid surgery and the risks and benefits can help you decide if you want to proceed.
Request An Eyelid Lift Consultation
Considering an eyelid surgery in New Jersey? Wondering if it will be covered by insurance? Dr. Smita. R. Ramanadham can help you obtain the results you want. Dr. Ramanadham will go over your options, goals, and more to determine if you’re a good candidate for eyelid surgery.
References
Eyelid Surgery Overview. (n.d.). Accessed at https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery
Eyelid Surgery Overview. (n.d.). Accessed at https://www.mayoclinic.org/tests-procedures/blepharoplasty/about/pac-20385174#