Typically, a patient must lose at least 30% of their total visual field owing to droopy brows and/or lid skin for insurance approval. Other medical reasons to have this done, include chronic irritation from skin folding with or without infection, or severe eye fatigue by the afternoon or evening, a night job, especially one requiring the operation of heavy machinery.
Will Insurance Pay For Upper Lid Blepharoplasty?
If you’re considering upper lid blepharoplasty, you might wonder if your medical insurance will cover the procedure. Let’s delve into the factors that determine insurance coverage for this surgery and explore your options.
Understanding Insurance Coverage
Medical Necessity vs. Cosmetic Procedure
In most cases, medical insurance is more likely to cover upper lid blepharoplasty if it is deemed medically necessary rather than purely cosmetic. If you experience functional issues with your upper eyelids that significantly impair your vision or cause discomfort, there is a higher chance that insurance will consider the procedure for coverage.
Factors That Determine Coverage
One of the primary factors that influence insurance coverage is the extent to which your vision is impaired due to your upper eyelids. If the sagging or excess skin on your upper eyelids blocks your field of vision and meets specific criteria set by insurance companies, you may be eligible for coverage.
Documentation and Evaluation
To determine if your case qualifies for insurance coverage, you will likely need to undergo a comprehensive evaluation by an ophthalmologist or a surgeon. This evaluation will involve assessing the extent of vision impairment and recording your symptoms.
If your main reason for considering upper lid blepharoplasty is cosmetic, insurance is unlikely to provide coverage. Medical insurance typically does not cover procedures undertaken solely for cosmetic purposes because they consider them elective.
Consultation and Verification
Speak with Your Insurance Provider
To understand your coverage options better, it’s best to contact your insurance provider directly. They can provide you with information on the specific criteria and documentation required for coverage.
In conclusion, whether insurance pay for upper lid blepharoplasty depends on several factors, primarily whether the procedure is deemed medically necessary due to vision impairment. Cosmetic considerations are generally not covered by medical insurance. To explore your options further and determine eligibility, consult with a qualified surgeon and contact your insurance provider for guidance. Understanding the potential coverage can help you make informed decisions about your upper lid blepharoplasty.
Check out our gallery of before and after images for blepharoplasty here.