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How to get insurance to pay for eyelid surgery?

Surgery on the eyelids is a typical method of improving one’s overall appearance. Excess skin and fat are removed from the upper eyelids during the operation, which results in a more youthful overall look. Bags under the eyes, caused by drooping lower eyelid skin and tissue, can also be eliminated with eyelid surgery. Eyelid surgery for purely aesthetic purposes is typically not covered by health insurance.

If the procedure is judged necessary, eyelid surgery may be reimbursed by your health insurance. As a form of corrective surgery, functional eyelid surgery involves the excision of excess skin from the upper eyelids. Reduced vision from drooping top eyelid skin can make even simple tasks like driving, reading, and texting challenging.

In order to evaluate coverage for eyelid surgery, the majority of insurance companies want documentation in the form of a visual exam. Only a qualified eye doctor, such as an oculoplastic surgeon, should administer the vision test. If the results of the eye exam indicate visual impairment, the surgeon will photograph the affected area and submit the evidence to the patient’s health insurance company. Depending on the details of the patient’s policy, the insurance company may pay for all or a portion of the expense of eyelid surgery.


What is the criteria for eyelid surgery?

When the upper lid skin and/or upper lid margin are at rest and elevated, a loss of at least 13 degrees or 31 percent of upper field of vision is required to prove that the proposed surgery or procedures are capable of fixing the problem (by taping of the lid).


How do you know if eyelid surgery is medically necessary?

In most cases, blepharoplasty is done solely for cosmetic reasons. Vision impairment due to eyelids can be considered medically necessary, however, if a visual field test performed by an ophthalmologist confirms this to be the case.


Does insurance cover lazy eyelid surgery?

The heavy, drooping eyelids might cause the patient to experience visual blockage in the superior visual field, eye fatigue while reading, and a brow ache from constantly elevating the forehead muscles to compensate. Blepharoplasty and ptosis surgery are typically covered by insurance policies when they are deemed medically essential.


Does insurance cover droopy eye?

Most health insurance plans will cover blepharoplasty or ptosis correction surgery if the patient can demonstrate that the condition “visually substantial” and “affects activities of daily living.”



Discover more about eyelid surgery at How much is eyelid lift surgery?

Learn more about blepharoplasty, read How long does it take to recover from eyelid surgery?

Read more on eyelid surgery at Blepharoplasty Santa Barbara, CA Eyelid Surgery Specialists

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