Eyelid lifting covered by insurance: The inside scoop
As an oculoplastic surgeon, I am often asked by patients when eyelid lifting or surgery is covered by insurance such as Medicare. There are two parts that are all necessary for insurance coverage of lifting the eyelid:
1. The patient should have visual symptoms from the drooping eyelid (Trouble seeing that affects daily living activities like driving, reading)
2. The eyelids should be low enough or have enough excess skin that starts to block the vision (This is confirmed with photography of the eyelids the insurance company looks at)
These are the basic requirements for eyelid surgery that must be fufilled to be covered by insurance such as medicare, united health care, blue cross blue sheild, aetna, cigna etc. There are several misconceptions that patients have about insurance coverage. First, having insurance coverage for a procedure does not mean your out of pocket expenses are zero. You may still have a copay, coinsurance etc which is part of your specific plan. The other thing is that the doctor can not "Write it up a special way" so it is covered. That may have existed in the 80s but not anymore. The insurance company uses a strict criteria of the three requirements to make sure that the eyelid surgery is coverable. There are no exceptions.
Often in my office my staff will check with the insurance to make sure that the eyelid surgery will be covered. When I see a patient I can guess to a certain extent but it is just that, a guess. The insurance has the final say. If you have a drooping eyelid are are not sure if it is coverable by insurance or want to get it fixed call our office at 303 468 8844 for a consultation.