Does insurance pay for hooded eyelids?

Author: Carlee McKenzie  |  Last update: Monday, June 2, 2025

To qualify for insurance coverage, obtain a referral from a primary care physician or specialist. They will evaluate your condition and determine if eyelid surgery is medically necessary. Medical necessity often includes cases where drooping eyelids impair vision. Make an appointment with your doctor.

How to get hooded eyes covered by insurance?

Answer: Insurance should cover your procedure but you need to see an eye doctor first to document obscuration of your peripheral vision and then be evaluated by a surgeon who can diagnose just what your problem is and whether its all lid or if the brow is involved as well. The recommended procedure would then be made.

How do you qualify for hooded eyelid surgery?

Do You Qualify For Eyelid Surgery?
  1. You have drooping or sagging eyelid skin that may also impair your vision.
  2. You have puffiness, bags, or dark circles under your eyes.
  3. Your eyes show signs of aging (n.b., drooping can be hereditary and may occur in younger patients)
  4. You are a non-smoker and in overall good health.

What makes eyelid surgery medically necessary?

When the eyelid muscle weakens, the condition is called ptosis. When there is excess skin and fat, the conditions is called dermatochalasis. But whether it's due to ptosis or dermatochalasis, both conditions can impair your field of vision, making eyelid surgery medically necessary.

How much does it cost to get rid of hooded eyelids?

The average cost of cosmetic eyelid surgery is $3,359 for an upper blepharoplasty and $3,876 for a lower blepharoplasty, according to the latest statistics from the American Society of Plastic Surgeons.

Is Eyelid Surgery Covered By Insurance? Surgeon Answers

How to qualify for eyelid surgery cost?

A visual field test will be needed, as many insurance companies require proof in the form of a visual field test in order to determine coverage for eyelid surgery. The photos and visual field will be submitted to the patient's insurance provider for approval.

How bad do hooded eyes need to be for surgery?

According to Dr. Wilson, there are a few key signs you may need droopy eyelid surgery. “If you feel like you can't see as well as you used to if you're using your eyebrows to lift your eyelids, or if you have to raise your head to see, these are all signs you may need surgery,” she said.

Who is not a candidate for upper eyelid surgery?

Certain conditions in your medical history may disqualify you from being one of the ideal candidates for eyelid surgery: A serious eye condition, like glaucoma or retinal detachment. Uncontrolled high blood pressure. Other uncontrolled medical conditions such as heart disease or diabetes.

Is a brow lift covered by insurance?

Generally, health insurance does not provide coverage for cosmetic surgery. With the brow lift, however, you may get your health insurer to cover the surgery if the skin over your brow is sagging to such an extent that it is affecting your vision.

How painful is eyelid lift surgery?

Blepharoplasty is one of the least painful cosmetic procedures. You may have some slight discomfort on the day of surgery, but you should feel better quickly.

How to pass a test for blepharoplasty?

Basically, for blepharoplasty to be covered, a visual field test needs to be performed by a licensed ophthalmologist. The findings of this test should indicate that there is a minimum of 30% or 12 degrees of upper field of vision loss, due to overlying upper eyelid skin.

What kind of doctor does hooded eyelid surgery?

Providers you meet with may include a plastic surgeon, an eye specialist (ophthalmologist), or an ophthalmologist who specializes in plastic surgery around the eyes (oculoplastic surgeon).

Does insurance cover Botox for droopy eyelids?

In most cases, insurance providers will cover Botox injections that are for medical reasons but not those for cosmetic purposes.

How long does blepharoplasty last?

The results of blepharoplasty (eyelid surgery) are generally long lasting. It's not uncommon for the longevity of results to vary slightly between patients, but you can expect the results of upper eyelid surgery to last about 5 to 7 years, and lower eyelid surgery results are essentially permanent.

Are hooded eyes a medical condition?

Since hooded eyes are a harmless facial trait, they usually don't require any sort of medical attention. If you notice one or both of your eyelids starting to droop suddenly, or the “hood” or droopiness of your eyelids make it difficult to see clearly, schedule an eye exam.

Who should not get upper eyelid surgery?

Eyelid surgery may not be right for you if you have thyroid problems, dry eye, high blood pressure, cardiovascular disease, diabetes, detached retina or glaucoma. Prior to the procedure, your plastic surgeon will evaluate your medical history and may advise you to see an eye doctor for an evaluation, as well.

How much does hooded eyelid surgery cost?

The surgeon's fee for eyelid surgery ranges from $3,000 to $9,000, depending on whether patients wish to address one or both eyelids.

How to get insurance to pay for eyelid surgery?

Documentation Requirements. To get approval for eyelid surgery, patients need substantial documentation. This includes medical records showing how droopy eyelids affect daily life and vision tests confirming impairment. Doctors often provide letters detailing why the procedure is necessary.

How do you qualify for hooded eye surgery?

Good candidates for eyelid surgery include:
  1. Healthy individuals with no medical conditions that can impair healing.
  2. Nonsmokers.
  3. Individuals with a positive outlook and realistic goals.
  4. Individuals without serious eye conditions.

Can you lift hooded eyes without surgery?

Non surgical eyelid lift options like laser resurfacing, nonsurgical skin tightening and lifting, dermal fillers, micro fat grafting, and even an enhanced skincare regimen can improve the appearance of both the upper and lower eyelids for some patients.

What is better than blepharoplasty?

By lifting the eyebrows, Ultherapy can produce subtle make your eyes look larger and less tired or droopy. Key factors regarding Ultherapy: Results occur within the first 3-12 months after treatment. Effects are milder than with Blepharoplasty.

How much does a non-surgical eyelid lift cost?

Average cost is around $1000.

What is the best non-surgical eye lift for hooded eyes?

BOTOX® Cosmetic: Neuromodulators like BOTOX® Cosmetic and Dysport® can improve the appearance of your upper eyelids by elevating the position of your eyebrows. These injectables help relax the muscles that pull your upper face down.

At what age do eyelids start to droop?

When do droopy eyelids start to appear? Droopy eyelids can occur at any age. Dermatochalasis and most cases of ptosis occur in people over 40 years old. However, ptosis can occur earlier, depending on the cause.

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