How can a lipectomy be determined as medically necessary by insurance?

I am an insurance collector in TX and have noticed more plans excluding lipectomy as cosmetic (including my own plan). I have a large golf ball-sized lipoma on my rib cage-near the incision of a previous lipectomy to remove a similar sized lipoma in 2002. How can the insurance consider this procedure medically necessary?

Doctor Answers 1

Symptoms = Coverage

Hello. Good questions. Most of the lipoma excisions I do are covered by insurance. The main reasons lipomas are usually taken out is that besides the fact that they are cosmetically displeasing, most patients experience some sort of discomfort from their lipomas. You actually have a few things in your favor that should get your procedure covered if you have a good insurance plan:

- size

- location

- recurrence

You have a large lipoma that has recurred after a previous excision in the same area. The rib cage is a sensitive location for a mass this size and as a result you are experiencing a considerable amount of pain and discomfort from its presence. It's removal is therefore justified.

Hope this helps. Good luck.

Sherman Oaks General Surgeon
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