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Will my insurance company pay for my upper eyelid surgery?

If the reason for the eyelid surgery is medical or functional, then sometimes the insurance company will pay for upper eyelid blepharoplasty or ptosis surgery. Medical or technical interference with vision is when the eyelids start to cover the visual axis or interfere with the top field of view. Insurance companies will only consider upper eyelid surgery cover in certain circumstances.
In the UK the authorisation for functional eyelid surgery varies between the insurance companies. Some companies will not cover any removal of healthy tissue at all from an upper eyelid. Other insurance companies, when provided with photographs showing the extent of the upper eyelid hooding and with visual fields showing functional impairment of the upper part of the visual field, will authorise for eyelid surgery to be done. Even then they may only allow for surgery on one eyelid and the other eyelid not be covered if one looks cosmetic rather than functional, in which case that will have to be paid for as a self-pay eyelid, by the patient.
It is worth being referred by your GP to the oculoplastic surgeon for functional eyelid assessment. After the evaluation, photographs and tests a report will be written for your GP, and you can send that to your insurance company for consideration for cover. The results of the photos and visual field tests sent to you too, and you should send those on with the medical report to your insurance company. You have to discuss whether your insurance company will cover your surgery.
The oculoplastic surgeon will also give you the surgery codes for the proposed operation which you have to quote to your insurance company.
There is one code for upper eyelid blepharoplasty and another code for ptosis. So if you also have a ptosis as well as excess upper lid tissue (dermatochalasis), additional codes will be given to you to provide your insurance company to request pre-authorisation for surgery.
However, please do not be disappointed if your insurance company does not agree to cover your upper eyelid surgery, even though you feel that you have functional problems from the excess tissue, heaviness and hooding. More often the insurance companies do regard upper eyelid surgery as cosmetic rather than functional and in that case, the oculoplastic surgeon, Ms Jane Olver at Clinica London, will provide you with a customised quote for your eyelid surgery.


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