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Eyelid surgery or blepharoplasty is covered by health insurance when the surgery is performed for reconstructive purposes, also called functional blepharoplasty. To learn more about the terms and conditions regarding insurance coverage for eyelid surgery, talk to our experts..
Eyelid surgery or blepharoplasty is covered by health insurance when the surgery is performed for reconstructive purposes, also called functional blepharoplasty. To learn ...more about the terms and conditions regarding insurance coverage for eyelid surgery, talk to our experts..Read More
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Eyelid surgery is covered by health insurance if the procedure qualifies as a reconstructive procedure, instead of a cosmetic procedure. If the procedure is reconstructive and has medical benefits, the insurer will provide ample coverage for the treatment.
The eyelid surgery performed to improve the visual field is called functional blepharoplasty. Following are the scenarios where the surgery is deemed medically necessary and covered by insurance-
The patient only needs to provide clinical evidence supporting that the droopy eyelids are obstructing the patient’s vision. Once these documents are submitted, the insurance company will verify them and provide approval as required.
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Pristyn Care Diyos Hospital, Safdarjung Enclave, DelhiInsurance companies consider blepharoplasty or upper eyelid surgery medically necessary when the patient can provide the following evidence-
The physician notes must clearly document- eyelid positions, reduced visual field, and the patient’s complaint about upper eyelids interfering with the regular activities, such as driving, reading, etc. The eyelid position must be measured by the physician using standard oculoplastic techniques and the margin to reflex distance 1 (MRD1).
The margin reflex distance 1 is the metric that is used to determine the degree of ptosis or retraction of the upper eyelid. It involves directing light at the patient’s eye and the distance between the directed light reflex on the cornea and the center level of the upper eyelid margin. The MRD1 value should be less than 2 mm.
Multiple high-resolution photographs of the eyelids and eyes should be taken that clearly indicate that the eyelids cover a significant part of the cornea and impair vision. The photos should also evidently clarify that the eyelid skin falls within less than 2 mm of the center of the pupil.
A detailed report of the visual field test should be submitted that evaluates the peripheral vision of the patient. The test is non-invasive and performed at the doctor’s office or clinic. The field of vision is first tested by placing both eyelids in their natural position. Then the eyelids are held up with the help of tape.
The difference between the taped and untaped visual field is noted and used to determine whether or not the insurance policy will cover the upper eyelid surgery.
Various expenses that are covered by health insurance policies, in general, include the following-
Insurance policies can also be customized according to the patient’s needs to cover extra expenses so that they can optimal care without worrying about the expenses. However, there will be some standard exclusions. To learn more about the exclusions, it’ll be best to talk to the insurance provider.
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Health insurance policies make surgical treatments cashless by covering the entire cost of treatment. The insurance company directly makes the payment to the network hospital in accordance with the policy’s terms & conditions. All of the costs incurred before, during, and after the treatment can be covered with the plan at the network hospitals of the insurers. Thus, the entire treatment becomes cashless for the patient.
If the cashless claim request is not approved, the patient can choose to file a reimbursement claim request to get compensation for the amount paid at the hospital.
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