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.
Archive for June, 2010
Will Health Insurance Cover My Blepharoplasty?
Where to Find an Affordable Massachusetts Health Insurance Plan
In this day and age of skyrocketing medical costs, health insurance is something you can’t afford to be without. Here’s how to find an affordable Massachusetts health insurance plan.
Exploring Your Options
Most people get health insurance through their employers. However, if you’re unemployed or your company doesn’t offer health insurance, there are still ways for you to get coverage:
* If you left a job that offered health insurance, look into COBRA coverage. COBRA lets you remain covered under your former employer’s health insurance plan for a few months at your own cost.
* Look into the state health insurance programs. These programs provide health insurance for Massachusetts residents who can’t afford private insurance. You can learn more Massachusetts’s state health insurance programs by visiting the Massachusetts Division of Insurance website.
* Group insurance from an organization. Employer health insurance plans cost less because you get a lower group rate. Buying health insurance through an organization such as your college alumni group or a professional group can get you the same type of discount.
If you don’t qualify for these options, you can still buy an affordable individual health insurance plan. Many types of individual plans are available: comprehensive coverage, major medical coverage, emergency coverage, short-term coverage, PPOs, HMOs, and more.
Finding Cheap Massachusetts Health Insurance
If you decide that an individual health insurance plan is your best option, then you need to start searching for an affordable policy. An insurance comparison website is the best place to start. On such a website, you complete a form with information about yourself and your health insurance needs. You then get fast quotes from multiple A-rated health insurance companies.
The best websites also let you talk with insurance professionals so you can ask questions and make sure you get the best health insurance plan for your needs and your budget (see link below).
Health Insurance Plans Covering Maternity
Many families are in search of affordable health insurance that will provide maternity or pregnancy benefits. Health carriers offer such plans, but they vary in the amount of coverage provided. Many insurers will not provide benefits to the insured for at least nine months.
As with all things insurance related, you must plan ahead. Occasionally, consumers are interested in maternity policies once they are already pregnant. They are disappointed to learn insurance cannot be purchased to cover a pregnant spouse – pregnancy is a preexisting condition. Insurers simply will not take on this risk. However, a health plan can be purchased for a healthy mother and child after delivery.
When is My Pregnancy Covered?
Generally, policies will provide benefits for maternity after the insurance has been in force for nine months, but some carriers offer plan with limited benefits that begin day one. However, if you were to purchase a plan with a nine month waiting period, your pregnancy would not be covered if the child was delivered before the nine month window had expired. Again, it is prudent to plan ahead and purchase a policy with a maternity rider some months before conception.
It might be helpful to look at this from the insurance provider’s point of view. Typically, when a couple desires and pays for a maternity plan, then they are likely to use it. The insurance company is relatively certain that a claim will come in the near future. Thus, they will build the cost into the premium for the insured (you) and mandate a waiting period. That being said, some companies are offering plans that are more attractive than others.
A Popular HSA Maternity Plan with a Reasonable Deductible
One insurance company offers a Health Savings Account (or HSA) with a maternity rider and a low $1,500 individual deductible. Once the deductible has been reached and the nine month waiting period has been satisfied, the plan would cover the balance of the pregnancy. In this example, you could fund the HSA account with at least the $1,500 and write that off against your income. The $1,500 could be withdrawn tax free to satisfy the deductible and then the policy benefits would kick in. Currently, this HSA plan is one of the more popular policies available.
Another popular plan has no waiting period and provides more benefits the longer the policy is held. The maternity rider will cover $2,000 toward a pregnancy in the first two years. During years three and four, the policy will pay up to $4,000 and years five and on the policy provides coverage up to $6,000.
Another option is to simply self insure for a pregnancy. Many consumers will purchase traditional health insurance or possibly an HSA qualified plan and save each month in order to cover maternity expenses.
How are Pregnancies Billed?
At this point, clients often ask about pre-natal care and doctor’s office visits. Fortunately, most Obstetricians do not charge as you go. Doctor’s visits, pre-natal care and delivery are all included as part of the pregnancy and usually subject to one, pre-determined charge. Thus, the final bill can be run through your insurance company (assuming you purchased a maternity rider) and then settled up.
When purchasing health insurance policies covering pregnancy, you must plan ahead. There are several options available, but you will get the most from your policy if you do your due diligence and purchase the policy ahead of time.
Request a Health Insurance Quote with Maternity



