Criteria For Insurance To Cover Eyelid Surgery

If it is 2mm or less your insurance company may cover the procedure. Have exclusions for eyelid surgery.

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If MassHealth approves the request payment is still subject to all general conditions of MassHealth including member eligibility other insurance and program restrictions.

Criteria for insurance to cover eyelid surgery. Eyelid surgery can be covered by medical insurance if it is deemed medically necessary. Insurance companies have specific criteria that must be met in order to get coverage and it may vary from company to company. Most insurance companies do not cover upper eyelid surgery.

Medicare will only cover your surgery if you have. Likewise an insurance company can drop your policy if you misrepresent your symptoms in order for insurance to cover a procedure. BCBSNC will provide coverage for Reconstructive Eyelid Surgery specifically Blepharoplasty andor Brow Lift Surgery when it is determined to be medically necessary because the medical criteria and guidelines shown below are met.

Insurance will cover eyelid surgery that is deemed Medically Necessary. Lower eyelid retraction surgery performed for functional indications. The Medicare Benefits Schedule code or item number 45617 for Upper Eyelid Surgery covers the condition involving ptotic drooping eyelid skin.

To be covered the typical criteria requires 1 - Photographs - We take medical grade photographs in the office demonstrating that the eyelid skin is negatively impacting your visual fields. Usually a potential patient must have a 30 percent loss of the upper field of vision and difficulty reading. Insurance companies have strict guidelines for coverage of upper lid blepharoplasty.

This Coverage Policy addresses lower or upper eyelid ectropion or entropion repair for corneal andor conjunctival injury or disease due to ectropion entropion or trichiasis. This must be documented by photos and visual fields. Blepharoplasty is considered medically necessary for any of the following indications.

Eyelid surgery technically called blepharoplasty is a procedure that removes excess skin and fatty deposits from the upper eyelids lower eyelids or both. This distance is normally 3-5 mm. Although a pre-authorization is very reassuring they are not a 100 guarantee of coverage.

To correct prosthesis difficulties in an anophthalmia socket. Ross Stutman MD Scottsdale Plastic Surgeon. However if a procedure is performed in order to restore function and a normal appearance insurance may cover the cost.

Eyelid lifting or blepharoplasty is considered medically necessary when it is used as a functional or reconstructive surgery. Proper diagnosis and documentation is crucial in improving the chance that your insurance company will cover the surgery. Occasionally commercial insurance companies such as Cigna Blue Cross etc.

All insurance companies are different and require different criteria to cover the costs of surgery. Reconstruction after thyroid eye disease children born with ptosis congenital ptosis and chronic dermatitis due to skin rubbing on the eyelashes are a few of these indications. The American Society of Plastic Surgeons notes that insurance companies will only cover the surgery when it is classified for reconstructive or functional problems such as ptosis drooping due to muscle weakness or nerve damage blepharochalasis eyelid swelling dermatochalasis excess skin herniated orbital fat excess fat floppy eyelid syndrome and visual field obstruction.

This is the distance between the light reflex I can see on a patients eye when shining a light directly onto it and the edge or margin of the eyelid. Functional eyelid surgery removes heavy skin that hangs over the eyelash line interfering with the line of sight. If vision is not impaired the surgery is considered cosmetic and does not meet Medicares criteria for coverage.

Feb 17 2020 Though the criteria is very strict you can receive insurance coverage for upper eyelid surgery when the eyelid significantly impairs your 10. Most health insurance does not cover cosmetic surgery or its complications. Eyelid Surgery Cost American Society of Plastic Surgeons.

Medicare does not typically cover cosmetic surgery such as eyelid surgery but you may be in luck if the procedure is considered medically necessary by a doctor. When performed solely for cosmetic reasons eyelid surgery is considered to be elective and therefore cannot be covered by medical insurance. I recommend you have a consultation with a board certified plastic surgeon to evaluate your eyelids.

Eyelid surgery and insurance. In some cases your insurance company will cover upper eyelid surgery. Only then that your insurance company may be able to pay for your surgery.

Additionally a statement by the patient as to how. Aetna considers any of the following procedures medically necessary when the criteria described below are met. In this case an eyelid lift to improve vision might be covered by insurance.

When eyelid surgery is performed to eliminate the redundant skin covering the 9. Wise uses a technique that results in the upper eyelid incisions hidden within the natural crease of the lid and the lower lid. For your own specific insurance is important that you read your policy determine your exact eyelid surgery insurance requirements.

They list the following acceptable indications for eyelid surgery. Please refer to the. This means it has to improve your vision in some way or decrease eye irritation.

Or To remove excess tissue of the upper eyelid causing functional visual impairment when the. For Medicare funding your upper eyelid skin must droop significantly and have an impact on your field of vision. MassHealth requires PA for blepharoplasty upper eyelid ptosis surgery and brow ptosis surgery and reviews requests for PA on the basis of medical necessity.

Visual field testing documents the degree to which the excess eyelid skin obscures your vision. The eyelid skin must be resting on or in front of the patients eyelids causing a significant restriction of their peripheral visual field side vision. An insurance company can drop our practice if we do not follow their criteria.

Functional eyelid surgery removes heavy skin from the upper eyelid area when it is interfering with a patients line of sight impeding everyday. However eyelid surgery is sometimes covered by an insurance provider if it is deemed a medical necessity. Oculoplastic surgeon denver eyelid specialist blepharoplasty cosmetic eyelid surgery tear duct surgery and orbital surgery 1800 emerson st suite 200 denver co 80218 303 468 8844.

Benefits Application This medical policy relates only to the services or supplies described herein. Occasionally there are other indications that insurance companies will accept to cover upper eyelid surgery. A pre-authorization means that the insurance company agrees that eyelid surgery is medically necessary and they plan on covering the blepharoplasty or ptosis repair.

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