One of the most common procedures for enhancing your appearance and reducing the signs of aging is eyelid surgery. Upper, lower, and double blepharoplasty procedures can all achieve this goal on varying parts of the eye. The popularity of these procedures means that many prospective patients ask the question, “Will insurance cover the cost of eyelid surgery?”.Understanding the limitations of your insurance coverage for eyelid surgery can be tricky, as the motivation for the surgery often dictates the answer to this question. Specifically, your insurance coverage, or lack thereof, will depend on the medical necessity of the procedure. Below, we discuss eyelid surgery and the factors that play a role in the limits of your insurance coverage.
Will Insurance Cover Eyelid Surgery?
Insurance companies have generally adopted the policy that they will provide whole or partial coverage for eyelid surgery when the procedure is being performed for functional rather than cosmetic reasons. For instance, your insurance policy may cover upper eyelid surgery if ptosis is interfering with your vision, but it will rarely cover lower blepharoplasty, which tends to be purely cosmetic.
How To Determine If Your Policy Covers Eyelid Surgery
1. Read your policy
Taking the time to sit and read over everything your policy covers will help answer most of your finance coverage questions. Ensure you look for information that is directly related to eyelid surgery coverage, but do not skim over other information that may be helpful. Your insurance company may have sections dedicated to general and specialized surgery coverage. You will need to understand both to ensure you have the most accurate answers. If anything about your policy is confusing, reach out to your provider directly for clarification.
2. Consultation and Exams
You will need to schedule a consultation with an ophthalmologist for general testing to determine the negative effects of your eyelids. Some insurance companies also require a comprehensive report from an eyelid surgeon to verify the medical necessity of the requested surgery.
3. Report Conclusions
After assessments have been concluded, your physician will compile a complete report that identifies the cause of your vision problems. Specifically, they will determine if the problems are related to excess skin or stretching, weakness of the muscle responsible for upper eyelid movement, heaviness or sagging in the eyebrow, or some other cause.
4. Pre-authorization and Approval
During your consultation and exam, your physician will likely take photos to document the eyelid’s position and summarize any issues or concerns. They will send this information to the insurance company and await pre-authorization and approval.
Your Unique Insurance Policy
Most insurance companies have policies that allow them to fully or partially cover the cost of eyelid surgery when it pertains to functional components. Insurance is more likely to cover the cost when your eyelid impairments impact daily life, cause pain or discomfort, or are likely to worsen if left untreated. You should note that insurance companies will rarely cover the cost of eyelid surgery when the motivation behind it is purely cosmetic. Nevertheless, you should be aware that policies can vary widely from one provider to another. It is best not to assume that your policy is the same as someone else’s. It is in your best interest to understand your specific policy and coverage so you can make a well-informed decision about your eyelid surgery options and potentially ease the financial burden associated with this procedure.
Eyelid Surgery in Hawaii
Insurance coverage for eyelid surgery ultimately depends on the level of medical necessity. Typically, insurance companies are willing to help cover the costs associated with eyelid surgery when the surgery will improve the function of the eye. If you believe you would benefit from eyelid surgery, talk to Dr. Bradford Lee about your options. His excellent care team can offer advice on your case and whether it qualifies as a medical need.
