Does medical insurance cover eyelid surgery? Healthcare insurance is essential, considering the cost of medical expenses in the US. According to a report, US healthcare costs have grown over 400% in the last 40 years. An overnight stay in the hospital in the US without insurance costs thousands of dollars.
Many people have chosen medical insurance because they are concerned with healthcare costs. However, there is a lot of concern among people while determining what healthcare services are covered by health insurance.
In the US, over 93 million people have a high risk of vision loss due to eye issues, as per an official report. If you are one of the people who have problems with their vision, you might ask this question "Does medical insurance cover eyelid surgery?".
This blog aims at answering that question and educating about the types of eyelid surgery and the medical insurance for eyelid surgery. Along with that, there are some important FAQs that you can't afford to miss right at the end of the blog!
What Is Eyelid Surgery?
Eyelid surgery, also known as blepharoplasty, is a surgical procedure performed to improvise the appearance of the eyelids or increase vision by correcting functional problems in the eyelids.
The surgery involves removing excess fat from above and below the eyelid. This procedure removes the droopiness or sagginess of the eyelids, making a person look tired, older, and unhappy.
During the surgery, incisions are made in the eyelids' natural creases, which allow the surgeon to target the fat in the area. The incisions are then closed with sutures or surgical tape.
Types of Eyelid Surgery
There are two main types of eyelid surgery; cosmetic eyelid surgery and functional eyelid surgery.
Cosmetic Eyelid Surgery
Cosmetic eyelid is a type of eyelid surgery specifically aimed at improving the appearance of the eyelids. It can be used to tighten the skin around the eyelid and improve the appearance of fine lines around the eyes. It can reduce the wrinkles and sagginess of the skin around the eyelid. It is also beneficial in removing the fat and skin from the upper and lower eyelid to give you a younger look.
Functional Eyelid Surgery
Functional eyelid surgery is used to remove functional issues in the eyelid. It is used to improve vision by correcting problems in the eyelids. Unlike cosmetic eyelid surgery, functional eyelid surgery is done to correct vision issues only. Functional eyelid surgery can correct droopy eyelids, eyelid ptosis, and eyelid malposition.
Does Medical Insurance Coverage cover these Surgeries?
Cosmetic Eyelid Surgery
Medical insurance usually does not cover cosmetic eyelid surgery since it is an elective procedure. If the treatment is deemed medically necessary, some insurance companies may cover part of the cost of the surgery procedure.
You must check with your insurance to understand what services your insurance plan covers. You may need to provide documentation and a medical evaluation from your healthcare provider to support the procedure's medical necessity.
Functional Eyelid Surgery
Functional eyelid surgery is covered by medical insurance in most cases as it is considered a medically necessary procedure. You can qualify for insurance coverage if you have a medical condition that causes functional problems in the eyelids.
You must check with your insurance providers to ensure your insurance covers your needs.
Cost of Eyelid Surgery
The cost of eyelid surgery varies from surgery to surgery that is being performed. The factors that decide the cost of eyelid surgery are the procedural complexity, surgeon, experience, etc.
On average, the cost of an eyelid surgery ranges from $2000 to $4000, and functional eyelid surgery's cost ranges from $3000 to $5000.
FAQs You Can't Afford To Miss
Is cataract surgery covered under medical insurance?
Most insurances like Medicare, Medicaid, and other private medical insurance deem cataract surgery to be necessary medically since it is used to remove the defect in the vision. Since cataract is an issue that affects the daily activity of a person, it is covered by most medical insurance.
But it's still essential to ask your insurance company about all the services offered. There are many cases when your doctor recommends against getting cataract surgery until the symptoms are prominent, ensuring that the treatment aligns with the insurance plan's guidelines.
However, pre-procedural diagnostics and treatments are not covered in most cases of cataract surgery. Some insurance plans may cover only the cost of the surgery, while some may also cover the cost of the intraocular lens (IOL) in the procedure.
Remember that insurance coverage does not mean the whole cost is covered. It usually means that the plan helps you pay the deductibles and copayments involved in the plan. Also, Asking your insurance provider about the services covered in your specific plan is essential.
Does medical insurance cover an eye exam?
Physical issues with the eyes are generally covered by healthcare insurance. In cases where eye exams are considered necessary, coverage by insurance plans starts. Eye exams that are related to diagnosing and treating eye issues like glaucoma, cataracts, and macular degeneration are covered by medical insurance.
However, eye exams that are done to determine the vision and prescription of classes are not covered by medical insurance. For these exams, you will need vision insurance(Note that vision insurance does not cover the "Medical" part of the eye exam, which is covered by the medical insurance).
You must find out the range of coverage that your medical insurance provides. Many vision insurance plans do not cover fittings of contact lenses and yearly evaluations.
How to get insurance to pay for eyelid surgery?
To get the insurance to pay for eyelid surgery, here are the steps you need to follow:
- Book your appointment with an ophthalmologist or a plastic surgeon.
- During the consultation after the appointment, the doctor will evaluate whether or not you are a good candidate for the eyelid surgery.
- You should discuss your symptoms and medical history with the doctor during the consultation.
- Obtain a referral from your primary care physician if your insurance plan requires it.
- Ask the doctor to send a pre-authorization request to your insurance company. This helps your insurance company understand the necessary information about the treatment and the condition.
- Follow up with your insurance company to ensure they've received the pre-authorization request from the healthcare provider.
It is important to note that the coverage of eyelid surgery varies between the provider and the plan. Be sure to check with your insurance agency to know if the coverage for eyelid surgery is provided in your plan.
Does insurance cover a blepharoplasty test?
The blepharoplasty test, which is the evaluation or consultation with a plastic surgeon or ophthalmologist, is not covered by insurance generally. This is considered a cosmetic consultation, and insurance does not cover it, making it an out-of-pocket expense for the insurance holder.
However, blepharoplasty surgery is covered under insurance plans when it is considered functional rather than cosmetic. Blepharoplasty is covered when the eyelid is causing problems deemed functional, i.e., they obstruct your vision, pain or discomfort around the eyes or impaired eye vision.
Suppose you meet the criteria of the blepharoplasty test. In that case, your doctor will send a pre-authorization request to your insurance provider so the services covered in your plan can be determined.
Does Medicare cover eyelid surgery?
Yes, eyelid surgery is covered by Medicare if it's done for functional purposes. Medicare will only pay for eyelid surgery if it is done to correct vision impairment and in cases when the issue is messing up with a person's daily routine. You need a medical referral so Medicare can pay for your eyelid surgery. You also need photographic proof so that Medicare covers your surgery.
If you fulfill all the criteria, the doctor will send a pre-authorization report to the insurance company, enabling your insurance coverage once the insurance company verifies if the service is within your plan.
So, in short, to the question "Does medical insurance cover eyelid surgery?" the answer would be yes, but only when eyelid surgery is done for functional purposes rather than cosmetic purposes. The procedure can correct functional problems in the eyelids, and the coverage depends from plan to plan.
Since the process is delicate and expensive, you must get a reputed doctor and a good insurance provider to balance the quality and the cost.