Liposuction for Lipedema covered under insurance? (Photo)

Question

I eat clean, run, have a personal trainer for 5 months. Desperately, I even tried starving myself. Nothing worked to get rid of my leg fat. It is also painful when touched. I thought they were cysts. My dr told me I have Lipedema. It was maddening that nothing I did worked, and I didn't know why. Now I know and I'm glad that I do. Now to fix it. I heard the only way to truly get rid of it is liposuction. Since this is progressive and will be debilitating, will insurance cover liposuction?

David Amron, MD · Answer

Lipedema is unfortunately not recognized by the majority of insurance companies. I am however amazed that gastric bypass surgery is covered by insurance when patients can lose weight by other measures, but lipedema surgery is still not commonly covered. The reality is that at the present time it is a great challenge to get covered by insurance. It is a specialized surgery called tumescent lymphatic sparing liposuction. It is not a typical cosmetic liposuction surgery. Make sure to seek out a surgeon with experience in treating lipedema, as there are factors with regard to pre and post care of surgery that differs from typical cosmetic liposuction. I believe and fight for hope with getting these surgeries covered by insurance, but the victories have been few and far between. The medical community is begining to raise awareness about this disease that is as common as 11% of the female population, and causes real debilitating pain and other conditions such as orthopedic problems. Finding knowledgeable and experienced providers, as well as support and coverage proves to be a challenge as of today, but I am hopeful that will change as time goes on and we continue to fight the fight.

Thomas Wright, MD · Answer

Insurance coverage for lipedema.
That is a really tough question to answer. The medical necessity criteria are complicated and some insurance companies make it very difficult to obtain coverage.  There 4 main national carriers [Aetna, BC/BS, Cigna and UHC].They all sell options that have general policies that may cover lipedema reduction with liposuction when all their stringent "medical necessity criteria" are met. The medical necessity criteria in documentation of a disability in performing at least one instrumental activity of daily life,  having specified BMI [Height and Weight], photos which in the insurance companies' medical reviewers subjectively agree as disproportion accumulation [The reviewers often don't agree with my assesment or other Lipedema experts assessments]. Other criteria include participation in a physician monitored weight loss program for at least 6 months and psychological evaluation.   However, in practice the specific individual  policy, your employer or you purchased, may or may not have a "coverage benefit" for the surgical treatment of lipedema.  Moreover the specific policy plan you are enrolled may have high deductible and Co insurance coverage, or the reimbursement is so poor, so that even when there is technically a policy covering the treatment, it can cost a good bit more when going through insurance.   Right now we do occasionally get medical insurance for coverage for lipedema reduction with liposuction, but most patients are much better off just paying cash or credit for the liposuction.

Jason Emer, MD · Answer

No liposuction is covered by insurance.  Even in cases of lipedema which are severe, it often is not covered.  I suggest seeing only a physician who is experienced with lipedema and uses multiple devices like WAL, VASER, MicroAire to get the best results.  Dr. Emer.

Robert Oliver Jr., MD · Answer

No, insurance does not cover liposuction surgery. I would also question a diagnosis of Lipedema with your photos as you show nothing remarkable with the areas of contouring you're asking about. Patients with true lipedema  have remarkable body changes from it that exist all throughout the body.

Connie Hiers, MD, FACS · Answer

Most insurance companies do not cover liposuction for any procedure. However, you can have your surgeon send for prior approval. Before sending for the approval, you may need your medical doctor to confirm the diagnosis and show that conservative treatments have failed. Most insurance companies require at least 3 months of conservative treatment before considering surgery.

Mats Hagstrom, MD (license on probation) · Answer

I am a patient advocate to the very end. I am always honest but will push the envelope to get insurance coverage for surgical procedures. I have never had an insurance company authorize liposuction for any indication. If you can find scientific evidence that liposuction helps treat the pain associated with lipedema, then you may have a chance of making an argument.When dealing with insurance companies, all procedures need to be associated with a certain diagnoses. The diagnoses are referred to as ICD-9 codes. Procedure codes are refers to as CPT codes. Generally, certain diagnoses automatically justify certain CPT codes.This will certainly initially be denied, and it will have to go to manual review. You will most likely need to appeal the initial denial. Sometimes a secondary appeal needs to be done as well. In order to have any chance of getting this covered, you have to have a plastic surgeon who is willing to submit paperwork and make phone calls on your behalf. Your insurance contract is a legal document with objective rules. I believe your only medical indication for getting insurance coverage is treatment of pain. I don't think there's any scientific literature backing this up. You need to do a search of the medical literature to find out the indications for the treatment of lipedema.Best of luck,Mats Hagstrom, M.D.

George Commons, MD (retired) · Answer

You may get insurance coverage or not.    Your surgeon needs to submit  to insurance with excellent full length photos and a history.    You may get partial coverage.   This is not an automatic coverage.  Find out your surgeons policy.   My Best,  Dr C

Liposuction for Lipedema covered under insurance? (Photo)

Answers (7)

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