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Christopher Hove, MD

Does Insurance Cover Eyelid Surgery? By crhove on February 17, 2020

A woman's eyesMany serious signs of aging become visible around the eyes, particularly the upper and lower eyelids. That’s why eyelid surgery (blepharoplasty) can make such a major difference to your looks. Countless people in the Philadelphia, PA area have come to Dr. Christopher Hove in order to have this drooping skin lifted, which has excellent anti-aging benefits.

While there are cosmetic advantages to undergoing blepharoplasty, there are times when this eyelid procedure is medically necessary. In these cases, eyelid surgery can be covered by insurance. Let’s explore this issue below.

Problems When Your Eyelids Affect Your Vision

Some people have eyelids that droop and sag significantly. This may be the result of sagging skin from the aging process, or an issue with the muscles that affect the muscles of the upper eyelids. The condition is called ptosis when the muscles are affected.

Not only does eyelid drooping impact someone’s appearance, it can also have a negative impact on vision. With a severely reduced field of vision, eyelid drooping can make driving and performing other daily tasks dangerous.

The Instance in Which Insurance Covers Eyelid Surgery

Though the criteria is very strict, you can receive insurance coverage for upper eyelid surgery when the eyelid significantly impairs your vision. In such cases of serious drooping or ptosis, the blepharoplasty procedure is no longer considered cosmetic but medically necessary.

Qualifying for Insurance Coverage

In order to qualify for your eyelid surgery to qualify for insurance coverage, you will need evidence that your case of drooping significantly affects your field of vision and peripheral vision. There will also need to be evidence that you are unable to perform certain daily tasks safely as a result of the drooping of your eyelids.

Getting the Necessary Medical Documentation

The exact documentation will vary based on your provider, but you will typically need photographic evidence and a recommendation by an ophthalmologist for upper eyelid surgery. This could include an official diagnosis of ptosis. Be sure to check with your insurance provider to find out exactly what is needed. This can prevent a lot of frustration with getting your surgery approved.

Knowing what documentation is necessary can be complicated, which is why patients who come to our Philadelphia practice can receive guidance on what documentation and evidence is needed. We can offer our years of insight into facial plastic surgery needs and help streamline this process so your procedure is approved as soon as possible.

Can I Also Have Lower Eyelid Surgery Covered by Insurance?

No.

The upper eyelids are the primary cause of vision impairment when a person suffers from ptosis or severe drooping. The lower eyelids generally do not have an impact on vision or quality of life matters. While puffy or hollow lower eyelids are a common issue for people, treating these issues is not considered a medical necessity that qualifies for insurance coverage.

Discussing the Procedure with You

In addition to discussing insurance matters, our team can also go over the various risks and benefits of the procedure. This will give you a good idea of what to expect from the procedure itself and the recovery process. By getting an overview of what the entire process entails, you’ll be ready for the insurance paperwork process as well as post-surgical healing.

Learn More About Eyelid Surgery

For more information about cosmetic eyelid surgery and why it may be an ideal option for you and your needs, be sure to contact a skilled facial plastic surgeon. You can reach our office serving the Philadelphia area by calling (610) 647-3727.

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Christopher R. Hove, M.D.

Hove Center.
Leaders in Facial Plastic Surgery.

Dr. Christopher R. Hove uses his refined skills and artistic touch to create exceptional results through facial plastic surgery. Specializing exclusively in facial procedures, Dr. Hove provides cosmetic and reconstructive surgery as well as nonsurgical enhancements. Dr. Hove is a member of:

  • American College of Surgeons
  • California Society of Facial Plastic Surgery
  • American Academy of Otolaryngology Head and Neck Surgery
  • American Board of Otolaryngology

Schedule a free consultation with Dr. Hove at our Paoli, PA, office by contacting us online or by calling (610) 647-3727.

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