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Will Insurance Pay for Eye Lid Surgery?

Eyelid surgery removes excess skin and fat from the upper and lower eyelids. The procedure may be combined with other procedures, such as a brow lift, to rejuvenate your appearance. While insurance does not cover cosmetic procedures for any reason, there are some exceptions for eyelid surgery.

Eyelid Surgery: Cosmetic or Medical Necessity?

Medical insurance only covers treatments and services that are medically necessary. Cosmetic surgery is not covered because it involves elective procedures that men and women choose to have for aesthetic purposes only. Eyelid surgery falls in a grey area, though. The procedure can be cosmetic or medically necessary; therefore, in some cases, insurance does cover a portion of the cost. 

When Insurance May Pay for Your Eyelid Surgery

When you have sagging in your upper eyelids, this makes you look older. The weight of the upper eyelids may also affect your vision, and this is when insurance may cover a portion of the cost. Sagging eyelids hang down over the eyeball and block vision. Additionally, the weight of the upper eyelids may cause eye fatigue, making it hard to keep your eyes open.

How to Qualify for Insurance Coverage of Eyelid Surgery

Your insurance may require pre-authorization for eyelid surgery to be considered medically necessary. Requirements vary by insurance carrier, so we recommend that you discuss your needs with your medical insurance carrier. Some examples of criteria that are used by insurance companies to deem eyelid surgery as medically necessary are

  • Clinically significant impairment of vision, as defined by skin that limits vision by 30° or more
  • Muscle laxity that interferes with proper function of the upper eyelid
  • Eyelids that are turned outward (ectropion) or inward (entropion)

Documentation That May Be Required

An ophthalmologist is the best resource when you believe that your eyelid surgery is medically necessary. Although Dr. Widenhouse may be able to provide some information to your insurance carrier, an ophthalmologist is the more qualified specialist to meet the requirements of your insurance. The ophthalmologist can provide the insurance carrier with a diagnosis and recommended treatment plan. Dr. Widenhouse can then perform the necessary eyelid surgery.

Will Insurance Pay for Lower Eyelid Surgery?

Lower eyelid surgery is more often considered cosmetic than upper eyelid surgery because the lower eyelids don’t affect vision. There may be some exceptions though, and we recommend that you discuss your symptoms with an ophthalmologist. Lower blepharoplasty may be medically necessary if you have nerve damage, abnormal growths, injuries, certain eye diseases, and other medical issues. Again, we recommend that you discuss coverage with your insurance carrier and consult with an ophthalmologist if you believe that your lower eyelid surgery is medically necessary.

Learn More About Eyelid Surgery

At Port City Plastic Surgery, we are always available to answer your questions about eyelid surgery and our other cosmetic procedures. Contact us today to schedule a personal consultation with Dr. Widenhouse. We have offices in Charleston and Daniel Island. He will discuss your concerns and review any findings from your ophthalmologist to develop a personal treatment plan for you.[/et_pb_text][/et_pb_column][/et_pb_row][/et_pb_section]


2683 Lake Park Drive
Charleston, SC 29406


125 River Landing Drive
Suite 101
Daniel Island, SC 29492