Is lipedema surgery covered by insurance?

Insurance companies make it very difficult to get reasonable coverage for lipedema reduction surgery.
First of all, first of all insurance company's " medical necessity" criteria is very subjective. For example, they ask for pictures and if the reviewers at the insurance company don't consider the adipose tissue on the legs out of proportion to the abdomen they will deny coverage for the lipedema surgery because it doesn't meet their "medical necessity criteria." There is no objective criteria that can tell you whether it's out of proportion or disproportionate and yet so insurance companies can say it is not disproportionate which is essentially telling the patient and all the doctors who diagnosed the lipedema that it is not lipedema so they don't have to pay.
Insurance companies also can can agree that a lady with lipedema meets medical criteria and then they cover it so poorly that it amounts to actually not covering it all. A great example of this is that the Blue Cross Blue shield will pay as little as $180 an in network 4- 5-hour surgery and consider that this " fair " in network reimbursement. Obviously this does not even come close to the actual cost to do the surgery. This has a tremendously discouraging effect for patients and providers who go through all of the hoops to get coverage and are basically rewarded with a screw you from the insurance companies. 
Now that I have explained the difficulties, you can certainly ask your doctor to try to help you get coverage if he or she thinks you have a decent chance. Then it is important the doctor is willing to document disabilities that lipedema is causing you. Wishing you the best of health

Yes, lipedema is covered by insurance
Several major insurance companies have written medical policies regarding the coverage of lipedema. Some do not. Getting authorization or approval to perform the surgery is not easy, and it does take quite a bit of time. It requires you to follow the requirement of your insurance company closely. In most cases, eventually, you will have to perform an appeal because a majority of the companies routinely deny primary requests. It’s a process. It does take several months. You have to be patient, and you have to become your own patient advocate. However, it is possible and doable. About 90% of our patients get coverage through the insurance. Hopefully, it helps.

Each insurance plan is different. We work with patients to get insurance coverage through single case agreements. Learn more in the link below.

To my knowledge medical insurance is not going to cover lipedema or liposuction for any underlying diagnosis with the exception as an adjuvant procedure for women we need secondary revision work for reconstructive breast after breast cancer. in those cases the procedure is not billed as Liposuction but as a reconstructive procedure.

There is no billable code for lipedema other than Liposuction or possibly Liposuction with skin resection.

I’ve never seen liposuction covered by medical insurance and for the most part it probably shouldn’t be.

You should most likely expect to pay for any liposuction procedure. You can always talk to a representative from your medical insurance company and see what they have to say.

When medical insurance covers procedures it is almost always based on having a certain ICD 10 diagnosis code which needs to be a covered benefit combined with an appropriate billable CPT code.



Best,

Mats Hagstrom MD