I recently went through the process of getting upper eyelid surgery because my lids were really affecting my vision and even my teaching. I submitted everything to my insurance, including the doctor’s measurements and photos, hoping they’d cover most of it. I ended up paying around $700 out of pocket after insurance kicked in, but I’m still not sure if that’s typical or if anyone managed to get full coverage. For those who have had upper eyelid blepharoplasty covered, how much did your insurance actually pay, and did you have to fight them on anything?
i went through a similar decision-making process about a year ago when I was considering upper eyelid surgery. What I found was that insurance coverage can vary quite a bit depending on your specific situation. Generally, if your eyelids are drooping enough to impair your vision, like mine were when I looked down at my dental charts, there’s a better chance insurance might cover part of it. I had to get a visual field test done by my optometrist to document the impairment, which my insurance used to justify partial coverage.
In my case, the total cost of the surgery was about $4,500, and insurance covered around 50% of that since it was deemed partially medical rather than purely cosmetic. It’s definately worth checking out what criteria your insurance company requires, some might have specific measurements or tests they want to see. Also, I had to be patient; the whole approval process took about two months, and I needed to supply quite a bit of documentation.
Another piece of advice is to talk to the billing team at your surgeon’s office. Mine was super helpful and knew the ins and outs of how to word things for insurance submissions. They even gave me a checklist of what to gather in terms of medical records and prior treatments. If you’re unsure, a consultation with a surgeon can help you understand what paperwork you’ll need and whether you might qualify for coverage.
Had upper eyelid surgery last year after dropping 70 pounds and definitely noticed my insurance covered the part where vision was affected. Mine took a bit of back-and-forth with doc letters but didn’t pay a dime for that part.
i think that varies so much, depends on the reason for the surgery