Can liposuction surgery be considered as a reconstructive surgery when it is performed to treat lipedema which is a disease?

My insurance covers "surgery to correct a functional defect" or "surgery to correct a condition caused by injury or illness if: (1) the condition produced a major effect on the member's appearance and (2) the condition can reasonably be expected to be corrected by such surgery". The insurance finally came around and covered Flexitouch pneumatic compression System. Any thoughts? Thank you!

Doctor Answers 5

Lipedema is not considered reconstructive surgery

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Hello there,

This is a great question. It is still a challenge that insurance companies are not recognizing lipedema as a disease that it is. Unfortunately, it is a matter of getting it covered in terms of more aspects of the disease, pain and other treatments to improve it. I don’t believe it is promising to call lipedema surgery reconstructive surgery. Please be sure to consult with a board-certified surgeon regarding your surgery needs. Thank you, best wishes.

Beverly Hills Dermatologic Surgeon
4.5 out of 5 stars 63 reviews

Insurance coverage

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My knee jerk answer is "No". I have petitioned on behalf of patients in the past without any success. I think you should plan on this being considered cosmetic.

Insurance for lipoedema

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I have never seen liposuction offered as a covered treatment. That is not to say that your insurer may not offer some alternate treatments for your proposed procedure. The quoted criteria are general and more commonly applied to cleft palate procedures.  You may want to search the carrier websites for their specific criteria applicable to a multitude of procedures.

Insurance coverage of liposuction

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Thank you for asking about your liposuction.

  • No insurance company I have worked with will pay for liposuction for any reason.
  • It is specifically excluded in many policies.
  • You need to contact your insurance directly to find out their position with respect to your liposuction.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Can liposuction surgery be considered as a reconstructive surgery when it is performed to treat lipedema which is a disease?

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Thank you for sharing your excellent question.  Lipedema is only now being recognized more and more by physicians, and it does respond well to liposuction.  Unfortunately insurance companies still deem correction to be "not medically necessary" and do not cover the costs for patients.  I would contact your insurance company directly and ask if they cover liposuction for lipedema and if so, ask for the necessary criteria for coverage.  Best wishes.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.