Are Blepharoplasty Procedures Covered by Insurance?

In most cases, blepharoplasty procedures are considered elective and cosmetic, meaning they are not typically covered by insurance. Insurance providers generally do not extend coverage to treatments or surgeries that are primarily performed for aesthetic purposes. As such, individuals seeking blepharoplasty to address cosmetic concerns, such as sagging skin, wrinkles, or puffiness around the eyes, may need to cover the expenses out of pocket.

When is Blepharoplasty Medically Necessary?

While blepharoplasty is primarily known for its cosmetic benefits, there are instances where the procedure is deemed medically necessary, making it eligible for insurance coverage. One common scenario is when drooping eyelids significantly impair a person's vision, leading to functional issues. When the excess skin or fat obstructs the natural line of sight, causing difficulty seeing and potentially leading to eye strain or headaches, insurance providers may consider blepharoplasty as a medically necessary intervention.

Additionally, individuals experiencing discomfort or pain due to the weight of sagging eyelids may qualify for insurance coverage. It's crucial to consult with both a qualified plastic surgeon and the insurance provider to determine eligibility for coverage based on individual circumstances.

Will Insurance Cover Blepharoplasty?

Blepharoplasty coverage depends on the specific circumstances of the procedure. If the surgery is performed solely for cosmetic reasons, insurance coverage is unlikely. However, if the surgery is deemed medically necessary, there is a higher probability that insurance will cover some or all the associated costs.

To determine coverage eligibility, individuals considering blepharoplasty should initiate a conversation with both their oculofacial plastic surgeon and insurance provider. The surgeon can assess the medical necessity of the procedure based on the individual's symptoms and vision impairment, while the insurance provider can provide information on the steps needed for coverage approval.

Navigating the Insurance Process

Blepharoplasty coverage requirements are different by insurance carrier. Individuals should start by checking their insurance policy to understand its specific guidelines regarding cosmetic procedures and potential coverage for medically necessary surgeries. Some insurance providers may require documentation, including detailed reports from an oculofacialplastic surgeon, outlining the medical reasons for considering blepharoplasty.

Medicare and Medicaid Coverage

At Natural State Aesthetics we require all patients who are interested in insurance services to have a referral from their eye doctor or primary care provider. If you have Medicare of Missouri or Arkansas and qualify for insurance-based procedures, your insurance will pay for 80% of the surgery. With secondary insurance you could get the whole surgery covered with Medicare. If you have Arkansas or Missouri Medicaid, regardless of your need your insurance will not cover the procedure.

Conclusion

Blepharoplasty is pursued for both aesthetic and functional reasons. While insurance coverage for blepharoplasty is often limited due to its elective nature, there are instances where medical necessity may qualify for coverage.