When is eyelid surgery covered by insurance?

At MOOI Clinic, we’re often asked if eyelid surgery is covered by health insurance. In exceptional cases, upper eyelid surgery is reimbursed. Lower eyelid surgery is never covered by your health insurance company.

Am I eligible for reimbursement?

An upper eyelid correction may be covered by basic insurance in certain cases. This is possible only if there’s a medical reason (or medical necessity).

When is there a medical reason?

  • Do you have an abnormality that you were born with?
  • Do you have a chronic illness?
    • Do you suffer from severe visual field impairment? (This involves the lower edge of your upper eyelid or overhanging skin hanging 1 mm or lower above the center of your pupil)

reimbursement health insurance eyelid surgery

What to do.

  • Think you qualify for insured care? Then ask your doctor for a referral to the plastic surgeon at the hospital for an upper eyelid correction.
  • Referred by the family doctor? Contact the hospital. The specialist assesses whether there is a medical necessity and then asks permission from your health insurance company.
  • Is the treatment covered by health insurance*? Then the treatment with one of our plastic surgeons takes place in one of the hospitals: Zuyderland in Sittard or Heerlen, the MUMC+ in Maastricht, or the VieCuri in Venlo.
  • No referral or approval authorization? Then you won’t be eligible for reimbursement for your eyelid surgery. In this case, we can perform eyelid surgery at MOOI clinic. For more information, contact MOOI Clinic.

eyelid surgery reimbursed insurance

Other treatments that may qualify for insured care include: tummy tuck, flap correction, scar correction and rhinoplasty. Again, the motto is, consult your health insurance for terms and conditions.

*To qualify for reimbursement, your situation must meet certain criteria. In addition, there may be maximum reimbursement (from supplemental insurance, for example) and payment of the mandatory deductible.

Have you been thinking about eyelid surgery for a long time?

Finding your own eyes and face MOOI again and feeling beautiful is what the MOOI clinic is all about. We’d be happy to tell you what your options are and what steps you can take.