How to get insurance to pay for eyelid surgery?

Tips for getting eyelid surgery covered by insurance

It is common knowledge how essential insurance is to everyone’s life. Not only does it help us stay secure in times of need, but it also provides financial protection against unexpected events that can cause significant loss. 

Similarly, medical insurance reduces stress and anxiety related to healthcare costs by helping individuals focus on their recovery rather than the payment. But does your medical insurance pay for eyelid surgery? If not, how can you make it happen?

How to get insurance to pay for eyelid surgery?

Your insurance company shall pay for your eyelid surgery if it qualifies as a reconstructive procedure and is considered as medically necessary. The saggy or droopy eyelids can cause a disruption in your daily life by impairing your vision, which can further lead to major difficulty in reading, driving, and using electronic devices. This is when eyelid surgery becomes a necessity for the patient and might require the removal of excess skin hanging over the eyelashes, lifting the drooping brow, or even raising the level of the eyes if it’s covering the pupil.

Your insurance company will require certain tests and standardized photos as proof of visual impairment so that you can proceed with the surgery. Another major step would be waiting for your insurance company’s approval and their decision on what portion qualifies as the cover, which depends on your insurance plan as well. However, most of the time, these companies have many rules and regulations which stop them from paying for many things like cosmetic surgeries. But, surgeries like blepharoplasty or ptosis, which disrupts your vision, can be covered as they are medically necessary. 

Before claiming insurance, you must follow some procedures. 

  • Check your insurance policy to determine if eyelid surgery is covered. 
  • Talk to a surgeon specializing in eyelid surgery who can assess your eyelids and decide if the surgery is medically necessary. If it is, they can provide proof to support your claim.
  • Your surgeon’s office can also submit the necessary documentation to your insurance provider. This can include a pre-authorization request outlining the medical need of the procedure.

What are the criteria for eyelid surgery?

The criteria for eyelid surgery can vary from person to person. But here are some common ones. 

  • If your upper eyelids have excess skin that hangs over the eyelashes, it can interfere with your vision or create a tired and aged appearance.
  • If your under-eye bags or dark circles do not improve with other treatments, eyelid surgery may be an option.
  • If your excess skin or drooping eyelids are causing impaired vision, eyelid surgery is necessary to improve your field of vision.
  • In some cases, eyelid surgery may be recommended to treat medical conditions such as ptosis, a drooping of the upper eyelid caused by weakened muscles.
  • You may choose eyelid surgery for cosmetic reasons to improve your appearance.

Is eyelid surgery a medical necessity?

Eyelid surgery, or blepharoplasty, can be both a medical necessity and a cosmetic procedure, depending on your circumstances.

In some cases, eyelid surgery is necessary for correcting a medical condition that affects the function of the eyelids, like ptosis, ectropion, or entropion. These conditions can induce discomfort, affect vision, and even lead to eye infections.

On the other hand, some individuals may seek this surgery for cosmetic reasons, to enhance the appearance of swollen eyelids, diminish eye bags, or lessen wrinkles around the eyes. While these concerns may not be medically necessary, the procedure can still have significant psychological benefits for the patient.

Ultimately, it is best to ask a qualified medical professional to specify if eyelid surgery is necessary in your case.

Frequently Asked Questions

1) How much does it cost to get eyelid surgery?

On average, the cost of eyelid surgery in the USA is $4,120, according to the American Society of Plastic Surgeons.

2) What is the best age to have eyelid surgery?

The best age to get this surgery is at the age of 30. But doctors recommend that one be at least 18 before getting a job. 

3) Is eyelid surgery risky?

As with any surgical procedure, eyelid surgery does carry some risks. However, with proper preparation and a good surgeon, most risks can be avoided altogether.
Some potential risks of eyelid surgery include the following:
i) Bleeding- There is a risk of bleeding during and after the procedure. However, your surgeon will take steps to minimize bleeding, such as stopping any blood-thinning medications before surgery and using precise surgical techniques.
ii) Infection- Any surgery carries a risk of infection. Your surgeon will take steps to prevent it by sterilizing equipment and following proper infection control protocols.
iii) Vision problems- In rare cases, eyelid surgery can cause vision problems, such as double or blurred vision. However, this is extremely rare and is more likely to occur in patients with underlying eye problems.
iv) Scarring- Significant scarring can occur after eyelid surgery, but most patients heal well and experience little scarring. But your surgeons will try to avoid that, making incisions in natural skin creases or using non-invasive techniques.
v) Dry eyes- Some patients may experience dry eyes after eyelid surgery due to changes in tear production. Your surgeon will monitor your eye health closely and prescribe eye drops or other treatments if necessary.

Wrapping It Up

We hope you found this article practical and informative. Don’t hesitate to contact your surgeon and insurance company for additional information on eyelid surgeries and your insurance rights.

Please take advice from your Insurance carriers before going through with the advice mentioned in this article. Insurance carriers offer up to date advice that may vary on case to case basis.

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