Will Insurance Cover my Eyelid Surgery?

Will Insurance Cover my Eyelid Surgery?

Eyelid surgery is a popular plastic surgery procedure performed in the United States and at the Oculofacial Surgery and Cosmetic Laser Institute. One of the most common questions we hear from our eyelid surgery patients is, “Will insurance cover my surgery?” Here, we answer that question in detail.

What Is Functional (Insurance-Based) Eyelid Surgery?

Eyelid surgery is commonly performed to improve a patient’s facial appearance. An upper lid blepharoplasty removes excess skin and fat on the upper eyelids to create an improved eyelid contour.

Eyelid surgery can also remove loose skin and tissue on the lower eyelids that create puffy bags under the eyes. Lower eyelid blepharoplasty to remove the puffiness and wrinkles under the eyes is considered cosmetic and therefore cannot be covered by medical insurance.

Eyelid surgery can be covered by medical insurance if it is deemed medically necessary and affects activities of daily living or ADLs. Functional eyelid surgery removes heavy skin that hangs over the eyelash line, interfering with the line of sight. Often the skin must be overhanging the upper eyelid reducing the distance from the pupil to the eyelid margin to qualify.

How Would I Qualify?

Impaired vision caused by excess, hanging upper eyelid skin can make everyday activities such as driving, reading, and computer work more difficult.

Patients often discuss brow pain from using accessory brow muscles to raise their eyelids. Studies have shown this muscle memory can take 1-4 years to resolve post-procedure.

Most insurance companies require proof through a visual field test to determine coverage for eyelid surgery. The field test needs to be performed by a board-certified eye doctor, such as an oculoplastic surgeon. If the visual field test determines there is visual impairment, photos are taken and attached to the note, and sent to the patient’s insurance provider. Whether the insurance company covers all or a part of the cost of eyelid surgery depends on the patient’s specific coverage plan.

Depending on your overall medical health, a decision will be made for you to undergo in-office laser-assisted eyelid surgery or hospital-based laser-assisted eyelid surgery.

Want to Learn More about Functional Eyelid Surgery?
The best way to find out if your medical insurance can cover all or a part of the cost of your eyelid surgery is to book a consult with Dr. Rosh.

What if I Don’t Qualify for Insurance-Based Upper Eyelid Surgery?

If your procedure does not qualify through your insurance provider, you still have options. The surgery can still be performed. The Oculofacial Surgery and Cosmetic Laser Institute offers financing plans with Care Credit to help patients pay for their procedures. A member of our team can discuss these options in detail with you during your consultation. For more information, please call or text our office at 813-303-0123 or contact us today.