Eyelid surgery can be performed for a variety of reasons. Some patients come looking for this procedure for aesthetic preferences, while others find that they need it to correct medical issues. Each can be performed by a competent eye surgeon. Below, we cover when does insurance covers eyelid surgery.
If you decide to get this type of work for medical reasons, you may encounter some challenges in terms of getting it approved by your insurance. However, there are ways to frame this procedure in order to get it approved.
When Does Insurance Cover Eyelid Surgery?
If you need to get eye surgery for medical reasons, then take a look at this guide to get your procedure approved. It likely could save you significant amounts of money.
Proving That It Is a Medical Problem
In most situations, this previously specified degree of severity is necessary in order for insurance to pay for ptosis therapy.
This is because the insurance companies need to be persuaded that the problem isn’t just a cosmetic one that the patient wishes to fix but rather one that raises medical concerns.
It can occasionally be difficult to persuade insurance companies to make payments under certain circumstances. It’s likely that in order to get insurance clearance, you’ll need to go through a number of medical tests and get a referral from your doctor.
What Is Ptosis?
Ptosis is a scientific term for a variety of fluctuating conditions affecting the area around the eyelid that affect a person’s ability to go about their daily life.
In general, it describes when the skin around the eyes and the area around the eyelids starts to droop and sag to the point where it becomes unsightly, harmful, or uncomfortable from a medical standpoint.
In the grand scheme of medical matters, the good news is that getting rid of this annoying ailment is not too difficult or dangerous. A proficient plastic surgeon is capable of adjusting the skin surrounding the eyes and exercising any areas that may be hindering or blocking. The circumstances surrounding each patient will vary based on how their unique case is developing.
Making a Strong Case
As previously mentioned, you will need to demonstrate that your ptosis or other medical issue is severe enough to need medical attention in order for your insurance to pay for all or part of the procedure.
The simplest approach to accomplish this is to list all the ways your disease interferes with your day-to-day activities and show your doctor.
There are several methods available for achieving this. Ranging from firsthand accounts to information from relevant authorities and acquaintances.
Varying Insurance Policies
Insurance policies vary in what they cover, and certain patients may find it simpler than others to make their case to their insurer. This is particularly true in the United States of America, where a vast array of insurance policies are offered.
During your pre-surgical meeting, when you go over all the practical options for your surgery in terms of both medical care and insurance, you’ll be able to go over the specifics of these policies with your doctor.
Articulating Your Specific Situation
You will have a meeting with your physician before the procedure to go over the specifics of your case and how ptosis affects you personally. You will talk about everything from your personal medical history to the kinds of drugs and supplements you now take during this meeting.
All of this will contribute to the information you need to establish a medical case for your ptosis. Furthermore, it might assist your physician in staying up to date on the best course of action for your particular situation. All things considered, it is the moment for you to assess what knowledge you require in order to comprehend your particular circumstance better.
Consulting with Your Physician
During your pre-surgical appointment, you will be able to get expert guidance regarding your eligibility for coverage. Many of the topics that are pertinent to you and your medical condition will be discussed with your doctor during this session.
Regarding whether or not your insurance policy will cover your procedure, your doctor may also be able to advise you or point you in the right direction to help guide you in your series of queries.
The Top Eyelid Surgeon in Mission Viejo
Dr. Ghosheh and the rest of the team at Advanced Eye Medical are some of the best eyelid surgeons in Southern California. If you have an eyelid surgery planned and would like to discuss how to get it approved by your insurance, contact us today in order to schedule a consultation with our Orange County eyelid surgeon.