Does My Insurance Cover Eyelid Surgery

BCBSNC will provide coverage for Reconstructive Eyelid Surgery specifically Blepharoplasty andor Brow Lift Surgery when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. Again most oculoplastic surgeons will be able to give a fairly accurate assessment of whether Medicare or an insurance company will cover blepharoplasty or eyelid surgery.

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Insurance companies do not generally cover the lower eyelid blepharoplasty but upper blepharoplasty is usually covered if an examination by an ophthalmologist determines that droopiness of the upper eyelid.

Does my insurance cover eyelid surgery. Eyelid surgery can be covered by medical insurance if it is deemed medically necessary. Insurance and Medicare approval for functional eyelid surgery can vary and continues to evolve with healthcare changes. When the eyelid is closing.

Most insurance companies have specific guidelines regarding criteria for covering eyelid surgery. First I take a photograph of the patients eyes from the front and sides. When Does Insurance Cover Eyelid Surgery.

During preoperative counseling ptosis versus dermatochalasis along with blepharoplasty and ptosis repair were discussed. Insurance will cover eyelid surgery that is deemed Medically Necessary. Sagging eyelids can have a significant impact on your appearance as well as your comfort.

Eyelid surgery blepharoplasty may be covered by Medicare if it is considered medically necessary and reconstructive rather than cosmetic. When there is redundant skin from the upper eyelid non cosmetic superior field cut. How Is Coverage Determined.

While insurance criteria can vary from one insurance provider to another typically there are a number of criteria that most insurance companies require to be met. Medicare Advantage plans Medicare Part C cover eyelid surgery if it is considered medically necessary by your doctor and they also offer an annual out-of-pocket spending limit which Medicare Part A and Part B do not offer. Posted November 19 2018 in Eyelid Ptosis.

Medicare does not typically cover cosmetic surgery such as eyelid surgery but you may be in luck if the procedure is considered medically necessary by a doctor. It depends but most insurance companies exclude cosmetic surgeries such as blepharoplasty from the list of covered operations. When the patient wishes to have a procedure even though there is no insurance coverage an eyelid lift is among the most affordable plastic surgery options.

You should visit and consult your ophthalmologist first. Both men and women are likely to develop ptosis of the eyes as they age because the surrounding skin and muscles become weakened. The American Society of Plastic Surgeons notes that insurance companies will only cover the surgery when it is classified for reconstructive or functional problems such as ptosis drooping due to muscle weakness or nerve damage blepharochalasis eyelid swelling dermatochalasis excess skin herniated orbital fat excess fat floppy eyelid syndrome and visual field obstruction.

Benefits Application This medical policy relates only to the services or supplies described herein. When blepharoplasty of the upper or lower eyelids is performed to improve ones appearance in the absence of any signs or symptoms of functional abnormalities the procedure is considered cosmetic and therefore not a covered service by Medicare or private insurance. Depending on how droopy the eyelids are an insurance company may cover a blepharoplasty.

While there may be subtle differences between different carriers most insurance companies base their criteria off Medicare guidelines. However eyelid surgery is sometimes covered by an insurance provider if it is deemed a medical necessity. Insurance companies will usually pay for reconstructive surgery to repair abnormalities caused by congenital defects trauma or disease.

Eyelid surgery offers promising results but it does come with a cost. The eyelid skin must be resting on or in front of the patients eyelids causing a significant restriction of. Will insurance pay for eyelid surgeryif it is affecting your vision.

Fortunately eyelid surgery addresses signs of aging around the upper andor lower eyelids to restore a more youthful and refreshed appearance. People considering eyelid surgery with facial plastic surgeon David A. For your own specific insurance is important that you read your policy determine your exact eyelid surgery insurance requirements.

Most of the time upper eyelid surgery lower eyelid surgery and even ptosis surgery will not be covered by your insurance. Eyelid lifting or blepharoplasty is considered medically necessary when it is used as a functional or reconstructive surgery. She underwent successful ptosis surgery and returned questioning whether enough skin was removed.

Sherris often ask if insurance will cover eyelid surgery. Plastic surgery procedures that are undergone for purely cosmetic purposes are not generally covered by health insurance. When Blepharoplasty Is Covered A blepharoplasty is only covered by medical insurance when it is considered a functional blepharoplasty.

However if in your case droopy lids limit your eye functionality and affect your vision it may cover the procedure. Insurance companies have strict guidelines for coverage of upper lid blepharoplasty. However if your ptosis is 22.

When Does Insurance Cover Eyelid Surgery. Functional eyelid surgery removes heavy skin from the upper eyelid area when it is interfering with a patients line of sight impeding everyday. Most of the time upper eyelid surgery lower eyelid surgery and even ptosis surgery will not be covered by your insurance.

If you notice vision obstruction your eyelid surgery may be deemed medically necessary and could therefore be covered by insurance. I will try to focus this article on insurance criteria required to cover blepharoplasty and or ptosis repair. You may however have to provide a physicians note and high-resolution photos of your eyes in order to demonstrate the necessity of your blepharoplasty to improve your vision and quality of life.

Please refer to the. This means it has to improve your vision in some way or decrease eye irritation. A 55 year old patient presented with drooping of both that blocked her vision when driving and reading books.

When performed solely for cosmetic reasons eyelid surgery is considered to be elective and therefore cannot be covered by medical insurance. When the treatment is for upper eyelids. They list the following acceptable indications for eyelid surgery.

She was found to have ptosis of both upper eyelids. Does my insurance cover eyelid surgery. This provides a visual field result which is sent to the insurance company.

Will Insurance Cover My Eyelid Surgery. To be covered the typical criteria requires 1 - Photographs - We take medical grade photographs in the office demonstrating that the eyelid skin is negatively impacting your visual fields.

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