Will Insurance Pay For My Eyelid Surgery Or Blepharoplasty?

Every oculoplastic surgeon is asked this on a daily basis. When skin is removed from the upper eyelids, this is called a blepharoplasty. Blepharoplasty may be performed to help increase one's peripheral vision or it can also be performed as a cosmetic procedure. This creates some confusion as patients often ask why their friend (or spouse) had their surgery covered, but their surgery may be considered cosmetic. Insurance companies, including Medicare, have strict criteria as to what they consider functional upper eyelid mechanical ptosis, or dermatochalasis. These are the diagnoses that are linked to the upper eyelid blepharoplasty procedure. Photographs and visual fields are used to assess the degree of visual impairment. So, every patient is different. Certainly, there is a cosmetic benefit to functional blepharoplasty, but many patients just want to improve their peripheral vision. This is generally the case in older patients. Younger patients often want the cosmetic benefit of upper eyelid blepharoplasty, and since it is not impairing their vision, this is cosmetic surgery. Lower eyelid blepharoplasty may be performed at the same time or independently. This is done to remove the lower eyelid bags or rejuvenate the the lower eyelid and midface. This is never covered by any insurance plan, as it is never visually impairing, but patients often choose to combine their upper eyelid surgery with this procedure. The cost of cosmetic upper or lower eyelid blepharoplasty depends on each individual surgeon and part of the country.

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