Does Insurance Cover Eyelid Surgery?

By dsherris on March 30, 2021


medical consultationHeavy eyelids, sagging skin, and excess fat deposits can all prematurely age the eyes. These types of imperfections often garner comments that a person looks tired or upset. Fortunately, eyelid surgery addresses signs of aging around the upper and/or lower eyelids to restore a more youthful and refreshed appearance.

Eyelid surgery offers promising results, but it does come with a cost. People considering eyelid surgery with facial plastic surgeon David A. Sherris often ask if insurance will cover eyelid surgery. We are happy to help individuals from Buffalo, NY, Rochester, NY, Niagara Falls, and surrounding areas explore their need for surgery and their insurance coverage to determine whether it may cover all or part of the cost of eyelid surgery.

Insurance Coverage for Cosmetic Procedures

Insurance coverage is meant to cover the costs of appointments, treatments, and procedures that are medically necessary. This means that, no matter what type of insurance coverage a person has, they should not expect it to cover the costs of cosmetic procedures, or those that are elective. In general, eyelid surgery is considered an elective procedure, because it primarily addresses cosmetic concerns. If eyelid surgery is being performed for purely aesthetic reasons, then patients should not expect insurance coverage, meaning they will need to cover the cost of treatment on their own.

Is Eyelid Surgery Medically Necessary?

While eyelid surgery addresses many cosmetic concerns, such as heavy, sagging eyelids and bags beneath the eyes, there are times when the procedure can be medically beneficial. If a person is able to demonstrate that eyelid surgery is medically necessary, then insurance coverage might pay for all or part of the procedure. If a person applies for insurance coverage for their eyelid procedure they will need to have proper documentation that it is medically necessary.

To demonstrate the need for eyelid surgery, patients have to work with a doctor, typically an optometrist. The optometrist needs to document that there are medical issues present that can be corrected through eyelid surgery. Most commonly, eyelid surgery is performed to treat obstructed vision due to overly heavy or hooded eyelids, or to address concerns such as inflammation or poor eyelid functions. In addition to written documentation from a medical provider, insurance companies may also request photographs of the condition before approving coverage.

Eyelid Surgery Payment Options

If insurance coverage does not apply to eyelid surgery, or if only a portion of procedure costs are covered, there will be out-of-pocket expenses for the patient. Covering these costs can put a strain on a person’s finances, but there are alternate payment options to consider. Many finance companies offer loans and/or credit cards that are specifically meant to cover the costs of medically necessary or elective cosmetic procedures. Our financing team can work with patients to find a payment option that works within their budget.

Contact Dr. David A. Sherris

If excess skin and sagging eyelids are aging your appearance or interfering with your vision, it may be time to consider eyelid surgery. Dr. David A. Sherris can help you determine if you are an ideal candidate for the procedure. To learn more, contact us online at your earliest convenience, or call (716) 884-5102.

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