People seek an eyelid surgeon for a variety of reasons, including personal preference, aesthetic concerns, professional desires, trauma, and medical necessity. Whether your health insurance will cover your cosmetic eyelid surgery depends on your condition, the reason you seek surgery, and of course your insurance.
Health insurance does not cover most cosmetic procedures because they usually are not medically necessary. Health insurance plans are there to help you when you medically need treatment, so while there are many good and legitimate reasons to seek eyelid plastic surgery, if your primary goal is to improve your appearance with no health benefit (other than peace of mind), then your insurance probably won’t cover the cost, nor should it have to. This is not to say that you should not seek cosmetic treatment or that you have few payment options; these are all points to discuss with your doctor, and you may be happy to learn that many doctors offer a variety of cosmetic surgery payment options.
How can I find out if my health plan will cover my surgery?
Health insurance does not cover cosmetic surgery. It may cover medically necessary reconstructive surgery. May is the operative word. Health insurance companies are increasingly unlikely to cover procedures that they previously did cover. This is their effort to maximize profit and minimize expenses. Examples of items that generally are covered include eyelid ptosis surgery because of vision problems, or if you have skin cancer and need mohs surgery for basal cell carcinoma, your insurance may help. To find out, call your insurance provider or read your insurance handbook. If you call, you can describe your situation and treatment desires, and also ask under what circumstances eyelid surgery is covered. Be honest and don’t try to scam an insurance provider into paying for care that isn’t really in your plan or that you don’t truly need for good physical health.
Will my Surgeon accept my insurance plan?
Check with your insurance to find out if they offer out-of-network payment. For reconstructive surgery, you will be asked to make a good faith deposit for surgery. As the doctor is not an in-network provider, his fees are likely to be more than what is allowed or paid by your health insurance. Following surgery, a courtesy bill will be provided for you to submit to your health insurance company. However, they are only obligated according to their fee schedule. The good news is that many health insurance plans do cover the hospital and anesthesia fees and part of their network. Because of how medically necessary surgery is billed, many patients are surprised to learn that they may actually save money when surgery is performed as self-pay cosmetic. If you have Medicare, you will be asked to sign a so-called opt out form that waives your right to bill Medicare for your surgeon’s work.
I want to see an Eyelid Surgeon, but my insurance won’t help.
There are a variety of ways individuals have financed their cosmetic treatment plan, including saving up or using CareCredit card, which offers care credit cosmetic surgery options. This leading patient payment program can help you to completely finance your cosmetic eyelid surgery on approval of credit. CareCredit is a great program that we are happy to offer as a service to our patients. This will enable you to seek treatment today that you can pay for in monthly installments.
Discuss Your Options
Depending on your need and condition, there is a good chance that your health insurance will cover a portion of your eyelid reconstruction in medically necessary situations.
Dr. Brian Evans MD is a board certified doctor with expert training in both cosmetic and reconstructive surgery, so he understands the complex anatomy and needs of the face. He is affiliated with multiple hospitals in the area, including Cincinnati Veterans Affairs Medical Center and San Joaquin Community Hospital.
Dr. Brian Evans provides a thorough first consultation to understand the requirements of patients.