If you want to look younger, but don’t want the pain of invasive surgery or the prolonged recovery time, then eyelid lift surgery may be right for you. Originally developed to address droopy eyelids, this procedure has expanded over the years to include many other cosmetic improvements in one simple step. But can I get insurance coverage for this? Many insurance companies will cover most of your eyelid lift cost if it’s a medical necessity. So how do you know if it’s covered? Here’s a quick guide to help you understand if your insurance plan will cover eyelid lift surgery costs:
You may find it hard to access the right information on the internet, so we are here to help you in the following article, providing the best and updated information on is eyelid lift surgery covered by insurance, Out-of-Pocket Expenses With Blepharoplasty. Read on to learn more. We at cosmeticsurgerytips have all the information that you need about DOES INSURANCE PAY FOR UPPER EYELID SURGERY?. Read on to learn more.
is eyelid lift surgery covered by insurance
A blepharoplasty is only covered by medical insurance when it is considered a “functional” blepharoplasty. This means it is done for medical reasons. It is not covered when it is performed as an elective cosmetic surgery.
If the skin around your eyelids sags and is impairing your vision and ability to perform daily tasks, a blepharoplasty can be considered medically necessary. Even when a blepharoplasty is covered by insurance, there will often be out-of-pocket expenses you will be responsible for the day of the procedure.
You cannot use health care savings accounts to help with the costs of a cosmetic blepharoplasty, but you can use a credit card or take advantage of special financing through the clinic.
Insurance Coverage for Blepharoplasty
A blepharoplasty is one of the most common cosmetic procedures to reduce signs of aging around the eyes, such as droopy eyelids, sagging skin, wrinkles, and bags under the eyes.
The procedure removes excess skin, muscle, and fatty tissue that can cause your eyelids to droop. By reducing droopy eyelids and sagging skin, an eyelid lift can minimize signs of aging and restore a more youthful appearance. It can be done on the upper or lower eyelids, or on both.
Medical insurance does not cover the cost of cosmetic procedures or surgery. If a blepharoplasty is done for cosmetic purposes, it is considered elective and therefore not covered. However, it may be covered when it is done for functional purposes and the blepharoplasty is considered to be medically necessary.
When Blepharoplasty Is Covered
In order for a blepharoplasty to be covered by medical insurance, the eyelid skin must be impairing your field of vision, usually your peripheral, or side, vision.
You will need an eye exam proving your lost field of vision as well as photo documentation and a statement on how your droopy eyelids are impacting your daily life. The eyelid skin must be obstructing your line of sight enough to make it hard for you to go about your daily life. The eyelid skin may droop enough to cover your eyelashes.
Functional blepharoplasties are covered by most major medical insurance companies when the excess eyelid skin impairs your functional vision. The following are examples of when a blepharoplasty can be deemed medically necessary and therefore covered by medical insurance:
- Your upper and/or outer visual fields are significantly impaired, and the visual field can be improved by at least 15 degrees.
- Corneal or conjunctiva irritation is caused by the drooping eyelids.
- Repair for lax muscles is needed due to ptosis.
- You have difficulty tolerating a prosthetic due to your upper eyelid position.
- Repair defects are present, caused by tumor-ablative surgery or trauma.
- You need the surgery to relieve chronic dermatitis, caused by too much eyelid skin that does not respond to alternative treatments.
- You need relief for painful or visual symptoms of blepharospasm.
Each insurance company has different plans and policies regarding coverage, and you will need to check with your provider directly to learn the specifics of your coverage. Coverage will depend on your plan, location, insurance company and provider, and where the surgery is done.
Out-of-Pocket Expenses With Blepharoplasty
The average cost of a blepharoplasty is over $3,000. This cost does not account for operating room facilities, anesthesia, and additional expenses related to the procedure. Even when the blepharoplasty is covered by insurance, there are usually out-of-pocket expenses involved.
The amount of money you will pay for your blepharoplasty depends on your specific insurance coverage, what your deductible amount is, and any copay fees you may have. Coverage may only extend to the procedure itself and not to other associated costs. Insurance coverage often has a cap, or a maximum amount of coverage, and this procedure can exceed that.
Get a detailed breakdown of costs from your surgeon, and confirm coverage details with your insurance provider, to ensure that you understand all of the potential fees and expenses up front.
Help With Costs Beyond Insurance
The cost of a blepharoplasty can be high, but the end result can offer relief from irritation as well as a more youthful appearance. If your eyelid lift is cosmetic and not covered by your insurance, there are other methods to offset the overall cost.
When a blepharoplasty is done for cosmetic reasons, you cannot use your HSA, FSA, or other health care spending or savings accounts to pay for the procedure. You can use a specialty credit card, such as CareCredit. These cards often give special financing for cosmetic procedures.
Another option is financing the procedure through the clinic or surgery center. Many clinics will offer payment plans and financing options to make the payment process more manageable.
DOES INSURANCE PAY FOR UPPER EYELID SURGERY?
Eyelid surgery, or blepharoplasty, can be performed on the upper lids, lower lids, or both. According to the American Society of Plastic Surgeons, there were nearly 210,000 blepharoplasties performed in 2017, making eyelid surgery the 4th most common cosmetic surgery procedure.
Many people elect to have eyelid surgery to improve their appearance if they have heavy or droopy upper eyelids. Surgeons remove excess skin, as well as muscle and sometimes fat, to tighten or “lift” the upper eyelids for a more youthful, bright-eyed appearance.
But oftentimes, heavy or droopy upper eyelids can affect a person’s vision. Sagging skin or excess fat on the upper eyelids can reduce your peripheral vision, particularly the upper and outer parts of your field of vision. Likewise, excess skin that covers the eyelashes can also impair your vision.
If an ophthalmologist or eye surgeon recommends eyelid surgery because your eyelids are affecting your vision, the procedure is considered medically necessary and therefore is typically covered by most insurance plans.
However, if heavy eyelids are not affecting your vision and you choose to have upper eyelid surgery anyway to improve your appearance, insurance probably won’t cover the cost. In addition, lower eyelid surgery is almost always performed solely for cosmetic reasons and as such isn’t covered by insurance.
According to 2017 statistics from the American Society of Plastic Surgeons, the average cost for eyelid surgery is $3,022, although costs can vary widely. The best thing to do if you’re considering upper eyelid surgery is to talk with an eye surgeon who specializes in oculoplastics, which means reconstructive, plastic and cosmetic surgical procedures for the eye.