One of the most commons questions my patients ask is, “does insurance cover Blepharoplasty, (also known as an eyelid lift)?” or “will my insurance cover eyelid surgery?”
This a great question. Most insurance companies have specific guidelines regarding criteria for covering eyelid surgery. While there may be subtle differences between different carriers, most insurance companies base their criteria off Medicare guidelines.
In general, insurance companies will cover Blepharoplasty or Ptosis repair if the eyelids cause a “visually significant” obstruction of the upper visual field that “affects activities of daily living”. To put it another way, if the upper lids block enough of your vision to significantly affect your life, then blepharoplasty or ptosis repair is considered medically necessary and may be covered by insurance.
So what are the criteria that insurance companies use to determine if blepharoplasty or upper eyelid surgery is “visually significant”, and therefore will be covered? There are 3 pieces of information they need:
1) Physician notes. These notes must clearly document the position of the lids, a decreased visual field, and a patient complaint about the upper lids interfering with certain activities (driving, reading, etc). The lid position should be measured using standard oculoplastic measurement techniques showing the lid or excess skin comes within less than 2 millimeters of the pupil (also called an MDR1 less than 2mm).
2) External ophthalmic photography. Basically these are high resolution photos of the eyelids and eyes. For criteria to be met, the eyelids or extra eyelid skin must clearly been seen to fall within less than 2 millimeters of the center of the pupil. Clear frontal and side photos are required.
3) Visual Fields. A visual field test is a noninvasive way to evaluate peripheral vision. This test is usually performed at an ophthalmology office. The field of vision is tested both with the eyelids in their natural position and with them held up (usually with tape). The difference between the taped and untapped visual field determines whether or not insurance will cover upper eyelid surgery. The visual field must improve by a certain percentage or certain number of degrees depending on the insurance carrier.
If the answer is yes, then the next step is to submit all notes and testing to the insurance company. The carrier will then either “pre-authorize” or deny the claim. A pre-authorization means that the insurance company agrees that eyelid surgery is medically necessary and they plan on covering the blepharoplasty or ptosis repair. Although a pre-authorization is very reassuring, they are not a 100% guarantee of coverage. Occasionally insurance carriers will do a second review of the case after the surgery has been performed.
Medicare works a bit differently. Medicare does not pre-authorize anything (any procedure- not just eyelid surgery). Medicare does, however, have clearly defined criteria that most oculoplastic surgeons know in detail. Based on the exam and testing, it can be determined if Medicare would typically cover a patient’s eyelid surgery. While most oculoplastic surgeons are correct in their coverage assessment, since Medicare will not pre-authorize surgery, a form called an “ABN” is usually completed and signed by the patient. The ABN typically states that while the surgeon believes Medicare will cover the Blepharoplasty or ptosis repair, the patient is responsible for the payment if the claim is denied. Again, most oculoplastic surgeons will be able to give a fairly accurate assessment of whether Medicare or an insurance company will cover blepharoplasty or eyelid surgery.
When the patient wishes to have a procedure even though there is no insurance coverage, an eyelid lift is among the most affordable plastic surgery options. It can usually be performed in the office, without the additional cost of general anesthesia or outpatient surgery assistance. Hopefully this gives some insight about the process and criteria for insurance coverage. Please contact us at (405) 418-5400 if you have questions or would like further information about Blepharoplasty.
If there’s a single procedure that can have a truly dramatic effect on a woman’s
perceived age, it’s eyelid surgery. Because the eyes are such a focal point of
most people’s faces, eyes that are showing the test of time can make a person
look old, sad, even angry. Sagging skin, fatty deposits, weakened muscles, loose
skin — it all combines to make your eyes make you look older.
But blepharoplasty, the clinical term for eyelid surgery, with Dr. Jones can take
10 years off a woman’s face. It can make you look more alert, youthful, and
Who can benefit most from eyelid surgery?
Eyelid surgery can remove excess skin that sags and obscures the natural folds
of the eyelids, excess skin that impairs vision, and bulging in the eyelids that
extends toward the nose.
These are problems with the upper eyelid, but eyelid surgery can also be
effective on the lower eyelid. There Dr. Jones can remove excess skin that is
forming wrinkles, eye bags, dark circles, and depressions along the lower eyelid.
Dr. Jones uses three techniques for his blepharoplasty procedures:
Upper eyelid blepharoplasty — Excess fat, muscle, and skin are removed
through an incision that is made within the natural fold of the patient’s upper eyelid.
Skin approach for lower eyelid blepharoplasty — This is the technique of choice if the patient has a good deal of excess skin to be removed in the lower eyelid area. The incision is again made in the natural crease.
Transconjunctival approach for lower eyelid surgery — In this technique the incision is made inside the eyelid to remove the excess fat and tissue. You cannot remove excess skin with this technique, however.
Interested in rejuvenating your eyes? Call Dr. Jones 405.418.5400 and schedule a consultation for eyelid surgery.
Forehead lines and crow’s feet aren’t all that will make you look older than you really are. Droopy upper eyelids and puffy lower eyelids are two equal culprits that age the appearance of both women and men. Fortunately, eyelid surgery can address the problem and make you appear more youthful and rejuvenated.
What eyelid surgery can do for you
The main goal of upper eyelid surgery is to remove sagging skin and reposition excess fat to correct drooping and puffiness, respectively. In some cases, upper eyelid surgery is done for medical purposes when significant amounts of excess skin start to interfere with a person’s vision.
On the other hand, the persistent appearance of eye bags can be permanently remedied with lower eyelid surgery. Excess fat in the lower eyelid area can either be removed or repositioned through a tiny incision just below the lower lashes or inside the lower eyelid itself.
Both upper and lower eyelid surgery may be done together if your plastic surgeon and the patient see the need.
Look younger in just 60 minutes!
A standard eyelid surgery takes about an hour and is generally performed as an outpatient procedure using local anesthesia or sedation. Bruising and swelling following surgery will most likely resolve after a week post-procedure.
Call us to schedule a personal consultation today. We aim to create an eyelid surgery plan that will be uniquely tailored to your cosmetic concerns and expectations.
Whether it’s removing excess, droopy skin in the upper eyelids or repositioning fat in the lower eyelids, eyelid surgery can provide dramatic outcomes. Additionally, new techniques in eyelid surgery have made it possible for the procedure to be performed quickly and achieve natural-looking outcomes in the process.
Deciding what you want
It can be difficult for patients to figure out what they want from eyelid surgery. Should they opt for upper eyelid rejuvenation? Or is fat repositioning in the lower eyelids more appropriate to restore youthful vibrancy? How about doing both?
Keep in mind that eyelid surgery is a way to bring back your eyes’ youthful luster rather than a panacea, erasing all visible signs of aging around your eyes.
Generally, you are an ideal candidate for eyelid surgery if you have the following specific concerns:
Extreme hooding of the upper eyelids
Puffiness or under eye bags
Wrinkling around the eye area due to muscle atrophy
Other things to consider before eyelid surgery
Anyone considering eyelid surgery should be generally healthy and free from certain disease conditions that can possibly affect surgical outcomes. These conditions include, but are not limited to, hypertension, thyroid problems, diabetes, glaucoma, and dry eye syndrome.
Talk to us today and we’ll help you achieve your eyelid surgery goals. Call 405.418.5400to schedule an appointment today!