This Is How to Get Insurance to Pay for Eyelid Surgery

Are you considering eyelid surgery to correct a condition or feature you don’t like?

Many people think about having plastic surgery, but they don’t know where to begin. If you want to make changes to your appearance, you have to start with an honest assessment of your health and your capability to pay for the surgery.

Every type of plastic surgery has its unique considerations. If you think you’re ready for upper blepharoplasty, read on for a guide on how to get insurance to pay for eyelid surgery.

Document Medical Necessity

If you’re looking to get insurance to pay for eyelid surgery, you should first make sure that you document and establish your medical necessity. Start by gathering any and all relevant medical/eye records, including any:

  • pertinent specialist visits
  • recommendations
  • referrals
  • visual field testing results

Also include other observables that create the narrative of your medical history and test results. Insurance companies may require signed documents and in-depth timelines of care. Be sure to include pictures or videos to further illustrate the documented problems.

Obtain a Physician’s Recommendation

Once all documents are gathered, it’s important to provide corresponding written evidence of the patient’s symptoms and medical professional recommendations. That makes the case justified and clear.

Also, have any necessary medical notes from any providers relevant to the excess eyelid skin surgery. You may also be prepared to supply proof of any payments already made towards the procedure to your physician upon their recommendation.

Submit Pre-Authorization Request

A pre-authorization request or prior-authorization request should include all of the pertinent information, such as the following:

  • patient’s name
  • date of birth
  • health insurance policy number
  • doctor’s information

To this form, any additional medical records or information regarding the patient’s medical condition should be included. In addition, the patient should include any expected costs associated with the eyelid surgery. Once this information is collected, it should be sent to the health insurance company for review.

The insurance company will then decide if the surgery is medically necessary and whether or not to cover it. If approved, the patient will be issued a pre-authorization number. This can be used to both schedule the appointment and receive the payment from the insurance company.

Check the Insurance Coverage Policy

To determine whether or not your insurance will cover eyelid surgery, you must ensure that you are familiar with your insurance coverage policy. To begin, review the policy and determine what types of cosmetic procedures are covered under your plan.

If an eyelid surgery like this upper blepharoplasty by Dr. Sykes is covered, then you can start the process of filing a claim for coverage. Once the claim has been approved, you can start scheduling your surgery.

Appeal If Necessary

Often, insurance companies will deny the request on the first try. If this happens, you should not give up. You should continue appealing until you can get a resolution.

By resubmitting your doctor’s medical records along with your written appeals, you can often explain why eyelid surgery is medically necessary and not a cosmetic procedure. Once the insurance company understands why the surgery is medically necessary, they may reconsider and cover some or all of the costs.

Learn How to Get Insurance to Pay for Eyelid Surgery

Eyelid surgery is a powerful form of facial plastic surgery that can yield dramatic results. To maximize the benefits of the procedure and to lessen your financial responsibility, make sure to research your insurance coverage. Learn how to get insurance to pay for eyelid surgery and get the insurance coverage you deserve!

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