Is Blepharoplasty Surgery Covered by Insurance?

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Blepharoplasty Surgery

Article at a Glance

  1. Insurance does not typically cover the cost of blepharoplasty surgery, as most insurance companies deem it a cosmetic procedure.
  2. Some patients may be able to receive blepharoplasty insurance coverage if their doctor can show that the procedure is medically necessary to improve vision or treat a condition that’s causing pain.
  3. Acquiring the proper documentation and pre-authorization from your insurance company can be a lengthy and challenging process.
  4. Consult with your surgeon to learn more about how to navigate the insurance landscape and explore other financing options.

Are you wondering about blepharoplasty insurance coverage? It’s completely normal to have questions and concerns about financing your operation. You can save time and frustration by researching ahead of time and knowing what to expect from your insurance company.

In this blog post, we’ll discuss everything you need to know about insurance coverage, from determining its viability to collecting the necessary documentation.

What is Blepharoplasty Surgery?

Blepharoplasty, also known as eyelid surgery, is a cosmetic procedure that removes excess skin and fat from the upper and lower eyelids. The most common goal of blepharoplasty is to improve the appearance of the eyes and create a more youthful look. Surgeons might recommend it for patients whose drooping or sagging eyelids give them a tired or aged appearance.

Blepharoplasty can also have functional purposes like improving vision or reducing pain. Ptosis (drooping eyelids), entropion (inward-turning eyelids), and dermatochalasis (excess skin on the eyelids) can all cause functional problems that surgery can help improve.

How Much Does Eyelid Surgery Cost?

The average cost of blepharoplasty surgery is $3000, though this number will vary depending on the surgeon’s fee, the procedure’s location, and the surgery’s complexity. Some patients may need to pay for additional costs like anesthesia, operating room fees, and post-operative care.

Eyelid Surgery and Health Insurance

With blepharoplasty’s associated costs, it’s no surprise that most patients wonder about potential eyelid surgery insurance coverage. The most straightforward way to check if your plan covers the procedure is to contact your insurance company directly.

Every policy is different, so you need to know the specifics of your coverage. Inquire about the type of documentation and pre-authorization required for coverage.

Qualifying for Insurance Coverage

Insurance companies typically do not cover cosmetic procedures like blepharoplasty — but there are some exceptions. If you have an eyelid condition that causes a “visually significant” obstruction to your vision and affects your daily activities, your insurance company may cover all or part of the cost of surgery.

Here are the three critical documents needed to prove medical necessity and qualify for blepharoplasty insurance coverage:

Physician Notes

You’ll need notes from your surgeon detailing the functional problems caused by your eyelid condition and how treatment will alleviate those issues. It should document the visual symptoms you experience and how they interfere with your life (for example, if you have to tilt your head back to see or if you experience double vision).

The surgeon will likely evaluate your lid position using standard oculoplastic measurements. Most conditions require a lid margin at least two millimeters below the center of the pupil to qualify for droopy eyelid surgery insurance coverage. In other words, the distance between the eyelids or excess eyelid skin and the center of the pupil should be less than two millimeters.

External Ophthalmic Photography

Your surgeon will take photos of your eyes from different angles to document the position of your eyelids and any functional problems caused by ptosis, entropion, or dermatochalasis. Insurance companies may require a specific minimum angle of eyelid droop, so the photos help determine if your eyes meet that minimum.

Visual Fields

Another blepharoplasty test for insurance is a visual field test, which documents any peripheral vision loss caused by your eyelid condition. This assessment, performed at an ophthalmology office, is non-invasive. It’s similar to the vision tests you take at your regular optometrist check-ups.

An expert will first measure your field of vision while your eyelids are in their natural position. Then, they will repeat the test with your eyelids temporarily elevated (often using tape).

The difference between the two sets of measurements will help your surgeon document any functional problems caused by your eyelid condition. Insurance carriers may require a certain percentage of potential vision improvement to cover blepharoplasty.

Other Cases for Coverage

There are other potential scenarios in which an insurance company may cover all or part of the cost of eyelid surgery. Let’s go over them one by one:

Reconstruction After Thyroid Eye Disease

Graves’ disease is a thyroid disorder that can cause the muscles and tissues around your eyes to swell. If you’ve recently received treatment for Graves’ disease and your eyelids are still causing functional problems, your insurance may cover reconstructive surgery.

Children With Congenital Ptosis

If your child was born with ptosis, their insurance company might cover the cost of corrective surgery — especially when it interferes with their vision.

Not all forms of ptosis will benefit from blepharoplasty, so your child will need an evaluation from a pediatric ophthalmologist to see if they qualify. Eyebrow ptosis, for example, stems from an issue with the forehead muscles, so eyelid surgery alone won’t correct it.

Treating Chronic Dermatitis

Chronic dermatitis is a condition that causes your skin to become inflamed, dry, and cracked. Excess eyelid skin can worsen symptoms as it rubs against the eyelashes. You may qualify for eyelid surgery insurance coverage if your dermatologist can document that blepharoplasty will help improve your symptoms.

Insurance Coverage Approval Process

Here’s a quick overview of what you can expect when you apply for insurance coverage:

  • Consultation. During your assessment, the doctor will review your medical history and symptoms, perform a physical examination, and take photos of your eyes. They may also order additional tests, such as visual field testing or external ophthalmic photography.
  • Submission. Once you have all the required documentation, you or your medical provider will submit a pre-authorization request to your insurance company. This is a formal request for coverage that includes all the information your insurance company needs to decide if they’ll cover the surgery.
  • Pre-Authorization. The review process usually takes a few weeks, during which your insurance company will likely request additional information from you or your doctor. You may receive a “pre-authorized” status during this time, which means that your provider deems the eyelid surgery medically necessary.
  • Approval. Most pre-authorized procedures receive final approval, but there’s a chance that your insurance company will deny coverage. Some carriers also conduct tests after the surgery to ensure that it has successfully improved your vision.
  • Appeal. Don’t give up if your insurance company initially denies your request — you can always appeal the decision. Talk to your doctor or a patient advocate if you need help with the appeals process.

Consult With a Blepharoplasty Expert Today

To get your eye lift surgery covered by insurance, you must partner with an experienced blepharoplasty surgeon who knows how to navigate the approval process. Dr. James Wang is a board-certified plastic surgeon with extensive experience with all types of eyelid surgery.

Contact our office to schedule a consultation and learn more about your blepharoplasty insurance coverage options. We’ll be happy to answer all your questions and help you start the approval process.

About The Author

Dr. James Wang - Facial Plastic Surgeon

By Dr. James Wang MD PhD

Dr. James C. Wang, MD and Ph.D., is the Facial Plastic and Reconstructive Surgeon at Northwestern Memorial Hospital. He graduated with Honors from the Texas Academy of Mathematics and Sciences Program at the University of North Texas in Denton, Texas.