How To Get Insurance To Pay For Eyelid Surgery?

One of the often done plastic surgery operations in the United States is eyelid surgery, which is also conducted at Eyesthetica, a cosmetic eye and facial surgery facility in Los Angeles. Will insurance cover my surgery? is one of the most frequent queries we receive from people undergoing eyelid surgery. Here, we give a thorough response to that query.

When Does Insurance Cover Eyelid Surgery?

Health insurance typically does not pay for plastic surgery treatments done merely for aesthetic reasons. Reconstructive surgery to correct deformities brought on by congenital malformations, trauma, or disease is typically covered by insurance companies. However, insurance might pay for a procedure if it’s done to get back to normal function and look.

Eyelid surgery, often known as “blepharoplasty,” involves the removal of extra skin and fatty deposits from the upper, lower, or both of the eyelids. The upper eyelid incisions made by Dr. Wise are concealed within the upper eyelid’s natural crease, and the lower eyelid incisions are buried inside the lower eyelid, leaving no visible scars.

Lower eyelid blepharoplasty is typically not reimbursed by insurance, but upper blepharoplasty maybe if an ophthalmologist finds that the droopiness of the upper eyelid compromises vision or the functionality of the eye. Please be aware that Dr. Wise’s eyelid operations are thought to be cosmetic in nature and are not, under any circumstances, covered by insurance.

The American Society of Plastic Surgeons’ suggested insurance coverage standards for blepharoplasty can be found here.

One of the least expensive procedures for the face is blepharoplasty. The average surgeon charge for eyelid surgery varies, according to the American Society of Plastic Surgeons, and the overall cost of the procedure is determined by the technique utilized as well as other elements including facility costs and the geographic location of the surgery. You get what you pay for when it comes to plastic surgery, and skimping on care to perform the procedure at a lower cost can have detrimental effects.

What Is Functional Eyelid Surgery?

Surgery on the eyelids is frequently done to improve facial attractiveness. To make the top eyelids look younger, the surgery removes extra skin and fat. Additionally, loose skin and tissue on the lower eyelids that cause puffy bags under the eyes can be removed with eyelid surgery. Eyelid surgery is seen as elective when carried out primarily for aesthetic purposes and is not consequently covered by health insurance.

If it is determined that eyelid surgery is medically essential, health insurance may pay for it. In order to improve vision, functional eyelid surgery eliminates bulky skin that hangs over the lash line.

Driving, reading, and sending texts can be challenging when one’s vision is impaired by extra, drooping upper eyelid skin.

When deciding whether to pay for eyelid surgery, the majority of insurance companies want proof in the form of a visual exam. A board-certified eye doctor, such as an oculoplastic surgeon, must conduct the vision test. The surgeon takes images of the issue and submits them to the patient’s insurance company if the vision test reveals a visual impairment. Depending on the patient’s particular coverage plan, the insurance provider may pay the entire cost of eyelid surgery or just a portion of it.

Learn More about Functional Eyelid Surgery

Meeting with a member of the Eyesthetica team is the best method to learn if your medical insurance can pay for all or some of the cost of your eyelid surgery. Before setting up a consultation, we encourage you to complete our eyelid self-exam so that we can get in touch with you to discuss your particular situation. You can make an appointment request by completing this form.

You still have options if your insurance company decides that eyelid surgery is not medically necessary. To assist patients in paying for their procedures, Eyesthetica provides financing options.

During your appointment, a member of our staff can go over these alternatives in greater depth with you. Please get in touch with us via phone or email if you want additional details.

Making the decision to get eyelid surgery is difficult and time-consuming. However, those sagging, drooping eyelids might become too much to handle at some point, therefore you’re currently conducting research to find the answers to the key concerns. When is eyelid surgery an essential medical procedure? How much does surgery on the eyelids cost? Insurance-related queries, however, are among the most often asked ones regarding eyelid surgery.

But when is eyelid surgery covered by insurance, and what criteria must be met for it to qualify as a covered medical procedure?

Functional eyelid surgery, which improves vision for some patients, is performed on the eyelids. One type of operation that can fit into this category is an upper eyelid lift. This comprises blepharoplasty, ptosis correction for the eyelids, and brow lift surgery.

The operation, which is most frequently linked to cosmetic surgery and aesthetic-type procedures, aims to reduce extra skin covering the upper eyelids or to widen them. Some people may see better with their eyelids slightly wide, and most frequently, people raise their eyebrows frequently to open their eyes, which is an indication of a drooping eyelid.

When eyelid surgery is performed merely to eliminate under-eye bags, it is seen as an elective procedure and is not reimbursed by insurance.

If it is determined to be medically required, one may be eligible for eyelid surgery that is covered by health insurance. The main reason given is that excess upper eyelid skin can impede eyesight and make daily tasks like driving, reading, and using electronic gadgets significantly riskier. If your droopy eyelids are causing you any particular problems in your daily life, tell your doctor.

If your eyelashes are covering your pupil, functional eyelid surgery may involve removing the extra skin that hangs over it, elevating the level where they sit, or, if your insurance plan covers it, lifting your sagging brow.

The first step is to check up with your insurance provider to determine if eyelid surgery is even a possibility before determining whether it is covered by insurance. Standardized photographs will be taken during your appointment so the doctor can assess whether the eyelid is obstructing your vision. You’ll need to take a visual field exam because many insurance providers demand confirmation of this in order to decide whether to cover eyelid surgery.

The patient’s insurance company will be asked to approve the images and visual field. Depending on the patient’s unique insurance plan, your insurance company may determine that you qualify for eyelid surgery through insurance for all or a portion of the treatment cost. It is vital to be aware that there are limitations that are outside of the doctor’s control and that your surgery may be deemed out-of-pocket and not reimbursed by your insurance. Many policies do not cover any type of brow surgery.

Additionally, Medicare and other insurance only cover one type of operation, not two, so if you have an excess of skin on top of a drooping eyelid, one of those procedures may have to be paid for out of pocket.

Although dermatochalasis (excess eyelid skin) and ptosis (droopy eyelids) are prevalent, your doctor may need to rule out additional conditions, such as:

  • increase in orbicularis oculi size
  • Keratitis
  • Blepharochalasis
  • Ptosis of the brow
  • Lagophthalmos
  • Malar adornments
  • a bulge of orbital fat
  • additional reasons for visual field abnormalities


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