When Does Insurance Cover Eyelid Surgery?

Eyelid surgery is a popular plastic surgery procedure that has the power to dramatically improve the appearance of the area surrounding the eyes and face. Below we answer the question: when does insurance cover eyelid surgery?

When Does Insurance Cover Eyelid Surgery?

However, like most intensive medical procedures, eyelid surgery requires approval from your medical insurance to cover it. You’ll have to address this issue unless you’re able to pay for the procedure out of pocket.

If you’re considering undergoing eyelid surgery and are curious about whether or not your insurance will cover the procedure, then take a look at this guide to that subject while you research droopy eyelid surgery in Greenwich.

Eyelid Surgery Basics

There are several types of eyelid surgery. Upper eyelid surgery is a surgery that focuses on the upper eyelids, while lower eyelid surgery focuses on the lower eyelid surgery.

In terms of having your surgery approved by the insurance, they likely will only approve you for upper eyelid surgery. This is because the issues that will lead to your procedure being deemed medically necessarily have to do with the upper eyelids drooping over the face, obstructing vision.

Medical vs. Aesthetic Procedures

Probably the biggest difference maker in terms of whether or not your insurance will decide to cover your procedure is whether you’re receiving treatment in order to fulfill aesthetic desires or whether the surgery is deemed medically necessary.

Conditions such as when your droopy eyelids reach the point where they are sufficiently obstructive to your day-to-day life, inhibiting your ability to perform essential tasks like driving a car or operating heavy machinery.

Should your insurance recognize your own procedure to be medically necessary, there’s a strong chance that they will approve it to be covered.

However, the insurance will need to receive proof of some kind that your operation is medically necessary. This means that you will need to undergo a series of tests, as well as take some photographs of your condition.

Ruling Out Other Conditions

If you can show to your insurance that your procedure is a functional eyelid surgery, they will likely approve you. However, your physician will need to rule out a number of other conditions that it could be.

Some of these include the following:

  • Keratitis
  • Ptosis
  • Malar festoons
  • Protrusion of orbital fat
  • Blepharochalasis
  • Hypertrophy of the orbicularis oculi
  • And many other conditions

Your doctor should be able to narrow down your issue to one that can be solved by functional eyelid surgery. And then they will move on to report this information to your insurance, which will expedite the process.

Patience Is a Virtue

First you submit your evidence to your insurance carrier for approval. Then you may need to wait a while before you are ultimately approved.

This owes to the fact that the medical insurance system is highly complex. And the process of approving patients for various operations can be quite laborious.

Given this, if you want your insurance to cover the operation, you’ll have to imbue yourself with a little bit of patience throughout the process. All in all, the approval process can take weeks and sometimes even months to complete.

Determining Your Physical Fitness

One thing that is bound to impact not only your surgery but how your insurance handles your request for coverage is your general medical situation.

Prior to your operation, your physician will pre-approve you for surgery. Things like your surgical history, family medical history, and general well-being will be taken into account.

Overall, this has the power to dramatically impact how health insurance institutions approach your requests. As you can see, it pays to live a healthy lifestyle!

Your Pre-Surgical Consultation

Much of the above-mentioned screening and testing will be performed by your physician in a series of pre-surgical consultations.

In addition, your consultation is your opportunity to converse with your physician. You can discuss all of the things you have on your mind regarding eyelid surgery. But also, you can learn about the process of applying for insurance coverage.

Overall, this period is the best time for you to field whatever information you might need from your physician in order to make your procedure smoother and safer. After all, safety is, at the end of the day, the highest priority in terms of medical operations.

Greenwich’s Eyelid Surgery Experts

Dr. Sohrab and the rest of her team offer quality blepharoplasty to the Greenwich area. If you’re interested in receiving treatment and are curious if you can get your procedure covered by insurance, then take a visit to our website in order to find out why Dr. Sohrab is considered one of the best oculofacial plastic surgeons in Greenwich.