Blepharoplasty surgery covered by insurance

If the excess eyelid skin is pushing down your eyelids and your vision is impaired, then insurance may help cover the costs.

The definitive test required by the insurance companies is the visual field exam - taped and untaped. You'll look at some flashing lights and push a button when you see the light. Then you'll repeat the test after having your eyelids taped up. The computer records how many you saw and how many you missed. It also keeps track of false positives and negatives, so it doesn't help to cheat.

If the test shows that your vision in the upper fields have improved by have your eyelid skin removed from your field of view, then insurance will likely cover it. Unless it's medicare, they may also require preop photos and a letter of medical necessity submitted to them for prior authorization before surgery.

Of course, all of this depends on your insurance coverage. Contact your insurance company to make sure that its not excluded from your policy. The procedure code is 15823. If it is covered, you'll still be responsible for meeting your deductible and co-pays, based on your coverage.

In most cases, insurance does not cover eyelid surgery. Removal of simple excess skin and fat from the upper and lower eyelids is considered "cosmetic" in most cases, where the goal is primarily improvement of appearance.

In select cases, where the upper eyelid skin hangs so far over the upper eyelid lash margin that this extra "hood" of skin actually blocks the peripheral vision, upper eyelid surgery should be a covered benefit of your insurance plan. In these cases, the upper eyelid surgery is performed for functional improvement, and therefore is "reconstructive" and not cosmetic in nature. It is important that your surgeon properly documents the medical necessity of the planned procedure with your insurance carrier before the procedure is done. Most commonly, this involves sending you to an optometrist or ophthalmologist to have computerized visual field testing, which documents the degree to which your hanging upper eyelids obscure the peripheral vision. The test is then repeated with your excess upper eyelid skin temporarily taped up in a higher (non-obstructing) position to show the improvement of your peripheral vision that should be expected following blepharoplasty for the upper eyelids.

Drooping of the brow and forehead may also contribute to the visual field obstruction, and your plastic surgeon should evaluate whether brow lift (in addition to, or in place of, upper blepharoplasty) is the proper treatment option for you.

Although most insurance carriers will make every effort to deny benefits even for legitimate functional surgery such as this, proper documentation and diagnostic studies will tip the balance in your favor, and your insurance carrier should cover at least a portion of the cost of the operation.

Insurance Requirements for Covering Eyelid Surgery

Once your vision becomes clearly impaired you should consult with an Oculofacial Plastic surgeon who specializes in correcting this type of condition. There are several things that are required by insurance companies.

-A Visual Field test should be performed, both untapped and taped. This will give both the doctor and the insurance company an accurate report on vision impairment.

-A complete exam by an Oculofacial Plastic surgeon

-Photos will be sent along with the Visual Field for Pre-certification.

If your vision is significantly impaired and the Visual Field and photos show the impairment your insurance company should cover the surgery.

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