Does Insurance Coverage Apply to Upper Eyelid Surgery?

By Peter Brownrigg on October 13, 2014

Older male and female with smooth and refreshed facial featuresPlastic surgery has become a popular option for patients who wish to address the signs of aging and achieve a more youthful, refreshed appearance. Because the skin around the eyes can take on a tired, haggard, and worn down appearance, it is no surprise that eyelid surgery, or blepharoplasty, is among the most popular cosmetic procedures. Eyelid surgery removes excess skin and fat from the eye area to create a more awake and alert appearance for patients. Upper eyelid surgery, in particular, cannot only refresh one’s appearance, but can also address problems with vision that have resulted from a heavy, or hooded, eyelid. When performed to improve vision, Dr. Peter Brownrigg’s staff can help our Ottawa patients explore upper eyelid surgery and insurance coverage to determine if benefits apply.

Does Insurance Apply to Cosmetic Surgery?

In general, the term “cosmetic surgery” applies to procedures that are performed for the sole purpose of improving one’s aesthetic features. As such, plastic surgery procedures are considered elective procedures and are not covered by the majority of insurance providers. However, there are exceptions in which “cosmetic” procedures are actually performed in order to improve health problems and quality of life. In these cases, some insurance providers will cover or assist with the costs of cosmetic surgery. Of course, each provider and insurance plan is unique, so this is something that must be discussed with each patient’s insurance provider.

Will Insurance Cover Upper Eyelid Surgery?

Upper eyelid surgery is one such procedure that is often performed not just to refresh a person’s appearance, but also to improve functionality. When the skin of the upper eyelid becomes excessively heavy, it begins to weigh down on the eyelid and can overhang the eyelashes, creating a type of “hood.” While this may create a tired, angry, or unattractive appearance, the greater problem is that it can actually obstruct a patient’s vision. This interference with vision is unsafe and can negatively impact the patient’s quality of life, as well as their ability to perform day-to-day functions. Removing this excess skin and creating a tighter, lighter upper eyelid is vital, in these cases, to restoring clear, unobstructed vision. Because this procedure has benefits that exceed the aesthetic benefits of a strictly cosmetic procedure, upper eyelid surgery may qualify for insurance coverage.

Working with Your Insurance Provider

It is important to follow the correct protocol when seeking insurance coverage for a cosmetic procedure such as upper eyelid surgery. Patients should always consult the insurance provider prior to scheduling surgery. In many cases, insurance providers will require documentation from the doctor detailing what problems are being experienced by the patient and how those problems will be addressed through surgery. Our staff can work with patients and their insurance provider to ensure that all required documentation is provided and that all eligible coverage is received.

Schedule an Appointment

If you are bothered by the tired, angry, or aged appearance that has resulted from heavy, sagging eyelids, or if you are having trouble seeing clearly due to overhanging eyelid skin, upper eyelid surgery may be the ideal solution. Schedule an appointment at your earliest convenience to discuss this procedure with Dr. Peter Brownrigg and learn if you are a good candidate for surgery. We look forward to hearing from you!

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