How to get Insurance to Cover the Cost of Eyelid Surgery

Eyelid surgery can be beneficial in a variety of ways. Not only will it help cosmetically but in some cases it can help your eyesight as well. If you are worried about the costs of this surgery we highly recommend you talk to one of our experience optometrists at Utah Valley Eye Center in Provo. They can determine your needs and the best way to go about having the surgery. Listed below are some of the steps that need to be taken if you want to have your insurance cover the cost of eyelid surgery.

The American Society of Plastic Surgeons notes that insurance companies will only cover the surgery when it is classified for reconstructive or functional problems such as ptosis (drooping due to muscle weakness or nerve damage), blepharochalasis (eyelid swelling), dermatochalasis (excess skin), herniated orbital fat (excess fat), floppy eyelid syndrome and visual field obstruction.

1. To determine your need you will need to first make an appointment with your optometrist. Document the need for surgery. Your doctor must indicate that blepharoplasty is medically necessary, documenting any of the following issues:

• Blepharochalasis
• Conjunctival (membrane the covers the white part of the eye) inflammation
• Dermatochalasis
• Edema (swelling)
• Eyelid and/or eyebrow ptosis
• Hypertrophy (enlargement) of the orbicularis oculi (muscles that work the eyelids)
• Keratitis (cornea inflammation)
• Lagophthalmos (poor eyelid closure)
• Malar festoons (bags)
• Protrusion of orbital fat
• Visual field defects

2. Have a surgeon take photographs to document the condition for which a correction is needed. Sometimes an insurance company will ask to see the photos and patients would need to sign a release form.
3. Get all pre-operative diagnostic tests suggested by your doctors. These may include:

• Bleeding and clotting studies
• Cardiac evaluation
• CBC (complete blood count) / SMA-7 (a blood metabolic panel)
• Schirmer’s test (dry eye test)

By following the steps above and receiving the proper diagnoses you could have help in paying for the costs of your eyelid surgery thanks to your insurance. Make sure you schedule your first appointment with Utah Valley Eye Center in Provo to get you started on the process.