You’ve invested your time, done the research, and decided that eyelid surgery is for you. When it comes to funding that surgery, things can become more complicated. Thankfully, we have made it a point to help you navigate the red tape and understand the technical aspects. A major question we get asked time and time again is, when does insurance cover eyelid surgery? The answer to that question is relatively straightforward. Insurance will only cover an upper blepharoplasty when it is deemed medically necessary.
What is Eyelid Surgery?
Eyelid surgery or blepharoplasty is a surgical procedure that edits the appearance of the eyelids by removing and shifting excess skin. Aging and genetics can cause the skin to sag. When this happens, getting a blepharoplasty may be a good option. Talking to an experienced medical professional can help you make the most informed decision for your needs.
Upper Blepharoplasty: Upper eyelid surgery refers to the removal of excess skin from the upper eyelids to create a more youthful and alert appearance.
Lower Blepharoplasty: Lower eyelid surgery targets under-eye bags and puffiness by removing fat from the skin under the eyes.
Combination: You can guess what combination eyelid surgery is, yep, upper and lower eyelid surgery. Some benefit from having both procedures done. The result is a rejuvenation of the entirety of your eye area, correcting both functional and aesthetic concerns simultaneously.
When is Eyelid Surgery Medically Necessary?
While the answer to when insurance will cover eyelid surgery is relatively straightforward, what is deemed medically necessary has a lot of grey areas. You can consult with an eyelid surgeon to determine if this type of surgery would be considered medically necessary. Furthermore, the best way to determine if your insurance covers eyelid surgery is to go directly to the source. Contact your insurance carrier, and they can tell you everything you need to know about their policies.
In most cases, medical necessity refers to eyelid drooping, discomfort, or obstruction of view. When the result is the correction of impaired vision or discomfort caused by the eyelid, insurance may cover eyelid surgery.
Insurance
Insurance has a way of making you jump through hoops to get things done. To save you time, let’s get down to the nitty-gritty. While it would be nice if insurance covered all procedures, that isn’t the reality. Certain insurance companies cover eyelid surgery deemed medically necessary to address any functional issues impacting vision or causing discomfort. What insurance typically does not cover is any procedure performed solely for cosmetic reasons.
Know Your Policy
Your best course of action for determining your coverage is to know your policy. Take the time to read over and understand the coverage you have. If your insurance covers medically necessary eyelid surgery, you will be required to provide supporting documentation. This can include but is not limited to documentation of the impairment, visual tests, and physician recommendations. Learn the requirements and limitations of your coverage first and foremost.
Should your surgery be deemed medically necessary, it is vital to secure detailed documentation from your healthcare provider outlining the reasons and how it impacts your health and overall well-being. Insurance companies may also consider pre-existing conditions. Surgery to improve function in relation to pre-existing conditions offers a higher likelihood of coverage.
Out-of-Pocket Expenses
Keep in mind that even with insurance, you may be responsible for any deductibles or copayments. Review your policy on out-of-pocket costs to help you with your budgeting. Furthermore, there may be other out-of-pocket expenses to consider. In addition to deductibles and copayments, you may be solely responsible for costs such as anesthesia fees, medications, and follow-up appointments. Knowing any additional out-of-pocket expenses associated with eyelid surgery can help you plan accordingly.
When Does Insurance Cover Eyelid Surgery?
In short, whether your insurance plan covers eyelid surgery will likely be contingent upon whether it is medically necessary. It is unlikely your carrier will cover any cosmetic procedures. Review your plan’s policy, know the requirements, and keep detailed documentation. These small steps can have a huge impact on your out-of-pocket costs for eyelid surgery.