Fine Lines: Having Blepharoplasty Covered By Insurance

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Fine Lines: Having Blepharoplasty Covered By Insurance

21 October 2015
 Categories: , Blog


If you've noticed your eyelids drooping more and more, especially as you get older, you might have thought this was just an effect of aging and that it's simply something you have to deal with. This is true, up to a point. Your eyelids can droop more as you get older -- a condition called ptosis -- but there's a point where the droopiness begins to invade your field of vision. Once it does that, you may be able to get the problem fixed on your insurance company's tab. But you have to be very careful because the companies want to be sure you're not doing it just for cosmetic reasons.

Evaluate Now

If all the ptosis is doing is making you look a little tired, and you have no problem seeing, then your insurance won't pay. But if you've had to tilt your head to get a better view of anything in front of you, or if you've noticed your peripheral vision suffering, get your eyes and eyelids evaluated. Insurance companies want to see that the ptosis is definitely impacting your vision to at least a certain degree; for example, some insurance companies require that the patient must raise the eyelid extend the field of vision by at least 15 degrees in order to receive coverage. This requirement is in conjunction with a few other requirements.

By documenting what you have now, you can see if you qualify to have the blepharoplasty paid for by your insurance. If you don't meet the requirements set forth by your insurance, you'll at least have a baseline in case the ptosis becomes worse.

Track Ability to See

Note how the ptosis blocks any part of your vision -- write it down. Do you have to tilt your head back so that you get a clearer view of something? Have you had to stop driving at night because your peripheral vision is obstructed enough to make checking your blind spot nearly impossible? Write those down so you have them on record.

Also, if you didn't qualify before, and you think your vision is getting worse because of the ptosis, get periodic evaluations to check the progress of the ptosis.

Don't Wait

The line between cosmetic and functional blepharoplasty -- that's one of the surgeries that fixes ptosis-related problems -- is very fine. Don't assume that just because you have had only minor problems that you wouldn't qualify. Maybe you're really good at adapting, and your ptosis is worse than you realized. Work with your doctor and insurance company to get the ptosis taken care of so you can see normally again. If you want more information about whether or not insurance will pay for a blepharoplasty, or if you need one to begin with, talk to your ophthalmologist.