One of the most frequently asked questions we hear from patients is whether their drooping eyelids are a medical condition or if it’s considered a cosmetic issue. This is a particular point of interest for many because when excess eyelid skin or drooping eyelid tissue is considered severe enough, some insurance plans will help cover the cost of surgery to correct the issue.
Obviously, having your insurance contribute toward a surgical procedure is helpful in reducing out of pocket expense. However, insurance criteria can be tricky and there are additional considerations that you should be aware of as you explore whether or not to proceed with eyelid surgery.
How severe is “severe enough” for insurance companies?
Each insurance company has different medical criteria and require a series of measurements, photographs, and diagnostic testing as part of their determination process. This is all done as part of a consultation appointment with our surgeon. They will listen to your specific concerns and carefully evaluate your eyelid tissue and muscle function, capturing all of the required information to submit to your insurance company for review. Here are some common signs that your eyelids might be “ready” for surgery:
Your eyelid skin droops and rests on your eyelashes, possibly even forcing your eyelashes downward
Your field of vision is limited by your drooping eyelids; patients often report bumping their heads on objects above their line of sight or don’t easily see cars approaching alongside them in traffic
You compensate for your heavy, drooping lids by raising your eyebrows and, as the day progresses, your brows fatigue, giving way to even greater drooping of the lids in the evening
Your eyelid tissue gets irritated or stings because the excess skin creates a notable skin fold where perspiration collects
If you are experiencing any of these symptoms, your drooping eyelids might be considered a medical condition. A consultation with our surgeon is the first step in determining if the status of your drooping eyelids is considered medically necessary in the eyes of your insurance plan.
You don’t have to wait for things to get “severe”
As you may have noticed, insurance plans are covering less and less and the medical necessity criteria is getting more and more difficult to meet. You may be experiencing issues with your drooping eyelids that inhibit the quality of life you want, but not yet meet your insurance’s medical necessity criteria.
Many patients feel that pursuing surgery before it’s “medically necessary” is vain or self-indulgent. We encourage those individuals to shift their thinking a bit. Having a brighter and fuller field of vision and enjoying how you look and feel while you engage in the activities that bring you joy is an important part of living a fulfilling life. Investing in yourself so that you can enjoy a greater quality of life is not a sign of vanity, but an act of self-care. Here are some comments we hear from patients about their bothersome droopy eyelids, despite their condition not meeting insurance criteria:
- People often think I’m angry or upset when I’m not
- People ask me if I’m tired, when I feel fine
- My mascara rubs off on my upper eyelid skin
- My eyeshadow collects in the folds of my eyelid skin
- Things don’t look as bright and when I lift my eyelid skin, things brighten up
Though insurance doesn’t consider these issues medically necessary for surgical correction, many patients choose to proceed with surgery electively and report the investment in themselves is something they appreciate each and every day.
Isn’t surgery expensive?
We don’t pretend that surgery isn’t a significant purchase. We have several payment options to help make things more convenient and affordable. For many qualified patients, an elective upper lid surgery can cost as little as $105-$125 per month!
If your eyelids are bothering you, we recommend starting out by just learning more about your specific condition and associated options. Arming yourself with information almost always helps you feel more empowered about your situation. You can start by visiting our website, viewing some of our patient’s before and after photos, or simply calling to schedule a consultation.
To schedule your consultation, please call us at 541-779-4711