Is drooping eyelid surgery covered by health insurance?


Quick Answer

Drooping eyelid surgery is covered by health insurance if it demonstrably improves vision or comfort but not if it is a cosmetic procedure, according to University of South Florida Health. Insurance companies typically require instances of medical need to be documented with photographs or proved by an appropriate eye test.

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Full Answer

Functional eyelid surgery (functional blepharoplasty) is performed for medical and not cosmetic reasons, and it is typically used to treat difficulties arising from eyelid skin falling over the eye and blocking vision; irritation from eyelid skin folds rubbing; forehead muscle discomfort; and difficulties in wearing glasses or contact lenses, says All About Vision. Eyelid drooping is known as ptosis, and it can be a congenital characteristic, a normal effect of aging, a consequence of eye surgery that decreases the strength of muscles holding the eye open or due to stroke or other trauma. Functional eyelid surgery is most often performed by oculoplastic surgeons and ophthalmologists, but other specialists, such as oral and maxillofacial surgeons, may also perform it.

Cosmetic eyelid surgery (cosmetic blepharoplasty) is not considered medically necessary, and it is typically performed to correct baggy, bulging or drooping eyelids, and sagging eyebrows, states All About Vision. The procedure is typically, but not only, performed by oculoplastic surgeons and ophthalmologists.

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