Assumption of costs for eyelid lift by the health insurance company

If the decision for an eyelid lift (Blepharoplasty) for purely aesthetic reasons, the costs must be borne by the patient. As soon as there is a medical indication, an application can be made to the health insurance company to have the costs covered. However, an ophthalmologist’s report confirming the necessity of the operation must be available.

The following are considered medical indications for the assumption of the costs of an eyelid lift

  • an upper eyelid that hangs so much that the field of vision is demonstrably restricted: This happens when parts of the upper eyelid extend over or up to the pupil. These drooping eyelids can be corrected quickly and easily. Surgery restores the full field of vision.
  • Repeated or chronic irritation of the eye due to severely drooping eyelids or pressure on the eyelashes: In this case, the eyelashes are pressed onto the eyeball and rub the cornea with each blink. In addition to the annoying and painful foreign body sensation, this also transports bacteria into the eye.
  • Inflammation due to the above irritation, but also permanent conjunctivitis of the drooping eyelids.
  • Moisture stagnation in pronounced skin folds, which promotes or can cause inflammation, eczema and fungal diseases.
  • a Ectropion on the lower eyelid: In the case of a Ectropion the lower eyelid rolls outward and loses its protective property for the affected eye. In addition, the eyelid becomes easily inflamed as a result.

Documents required for reimbursement

It is important to know that the health insurance company is not obligated to cover the costs. Even if there is a medical indication, the application may be rejected and you will still have to pay for the surgery out of your own pocket. To get the application approved, you need to submit some documents.

These include:

  • an accurate cost estimate listing the individual items (preliminary discussion, operation, aftercare, etc.) and the prospects of successful recovery: this estimate should be issued by the operating physician.
  • a photo documentation of the eyelid area, which conforms to current standards and is best performed by an ophthalmologist or the operating physician
  • the results of an ophthalmologic measurement of the visual field
  • and the ophthalmological findings with request for assumption of costs by the health insurance company

Before a decision is made by the health insurance company, the patient is often ordered to undergo an examination by the medical service of the respective health insurance company (MDK). The examination is intended to confirm the findings before the request is approved.

If the application for assumption of the costs for an eyelid lift is rejected

If your application is rejected, you can Appeal and submit it a second time for reconsideration. Often persistence is enough to get the application approved after all. In general, private health insurance companies cover the costs of an eyelid lift more often than the statutory health insurance companies.

Some health insurance companies also cover only part of the costs, even if they recognize the necessity of the operation. To avoid nasty surprises, you should definitely clarify this in advance. If your health insurance company determines that your surgery must be paid for by yourself, this also applies to any follow-up treatment that may be necessary.