Most of the blepharoplasty patients I see at my Toronto and Oshawa, ON, practice undergo the procedure for cosmetic reasons. Excess drooping skin creates the appearance of being constantly tired or generally looking older, and patients want to look refreshed and more youthful.
But for some patients, blepharoplasty, or eyelid surgery, takes on a bit more urgency, such as when that droopy, excess eyelid skin sags enough to significantly impair their vision. In those cases, health insurance will cover the costs of upper eyelid surgery.
When is blepharoplasty covered by insurance?
Qualifying to have insurance cover the cost of upper eyelid surgery involves meeting certain criteria. The procedure must be deemed “medically necessary,” rather than performed for cosmetic reasons. A few points to consider as you think about whether insurance is likely to cover your specific case:
- If your vision is significantly and unambiguously inhibited by the presence of excess eyelid skin (dermatochalasis) from the upper eyelid, the procedure will be covered by insurance.
- In order to gain insurance coverage, you’ll also need to have a documented examination by a physician. You may also need to have a visual field test that demonstrates markedly improved vision when the eyelid skin is temporarily taped out of the way.
- Insurance typically does not cover lower eyelid surgery.
If you are getting upper eyelid surgery to improve your field of vision, the Ministry of Health in Ontario will cover the cost, provided that an optometrist documents at least a 50% reduction in your visual field.
Will it be covered if I have lower eyelid surgery too?
In many cases, a patient whose upper eyelid surgery is being covered by insurance decides to have lower blepharoplasty performed during the same operation. That’s perfectly fine, but only the upper eyelid surgery is covered by insurance.
How do I find out if my eyelid surgery would qualify?
If you’re not sure whether you qualify for insurance to cover the cost of upper blepharoplasty, the first step is to schedule an appointment with an optometrist to test your field of vision.
What happens if my insurance denies coverage?
If your insurance denies coverage, you still have options. Talk with your surgeon’s office about financing plans or payment options. Some practices offer solutions to make procedures more affordable.
What are common reasons insurance denies coverage?
- The procedure is deemed cosmetic rather than medically necessary.
- Inadequate documentation from a physician or optometrist.
- Failure to meet specific insurance criteria, such as measurable vision impairment.
What does blepharoplasty cost without insurance coverage?
The cost of upper eyelid surgery is usually around $6,000. The cost will increase if you combine it with lower eyelid surgery, an endoscopic brow lift, or another surgery. I break down the costs of different types of eyelid surgery, including upper blepharoplasty in a recent blog post.
Can I combine blepharoplasty with other procedures?
Yes, many patients opt to combine upper eyelid surgery with lower blepharoplasty or a brow lift to achieve a more comprehensive rejuvenation. While insurance will only cover the medically necessary portion (upper eyelid surgery), combining procedures during one operation can save time and recovery effort.
Talk With a Plastic Surgeon
If you’re concerned about sagging eyelids or a heavy brow, I’m happy to talk with you about your surgical options. In some cases, I combine a brow lift with eyelid surgery to give my patients the best results (although brow lift surgery is not generally covered by insurance).
You can see the results of some of my actual eyelid surgery patients by visiting my online gallery of before and after photos.
To schedule an appointment, use our online form to request a consultation or call us at (416) 925-7337 to schedule a consultation.
I am interested in upper eye lid surgery.
Thank you for contacting us. Please call the practice at (416) 925-7337 to schedule a consultation.
im interested to see if i qualify for surgery covered by OHIP
Thank you for contacting us. Please call the practice at (416) 925-7337 to schedule a consultation.
Would having the top lid and bottom lid done at the same time cause vertigo or dizzy?
Thank you for contacting us. Please call the practice at (416) 925-7337 to schedule a consultation.
I am 76 years old, my upper eyelids are very droopy causing vision problems.
Can you help me?
Thank you for contacting us. Please call the practice at (416) 925-7337 to schedule a consultation. Our surgeons will perform a full assessment to determine the best treatment for your needs.
Hi, I have significant droopy eyelids, when I maintain rested face,I also sustained a eye Injury 2 years ago, where now my muscles in eyelid are weakened more. What do I do to see if Ohip can cover
Thank you for contacting us. Please call the practice at (416) 925-7337 to schedule a consultation.
I have very droopy eyes and feel like i have to look downwards to read, i am wondering how to quantify for this repair BLEPHAROPLASTY by ohip. I’m also from Bruce County so wondering about a zoom or phone appointment
Thank you for contacting us. Please call the practice at (416) 925-7337 to schedule a virtual consultation.