Will insurance cover liposuction for my lipedema? (Photo)

Question

I have been diagnosed with stage one Lipedema. I know that it is progressive and harder to treat when it gets worse. It was so frustrating for so long because I would diet, work out to excessive, worked with a traitor. I was even desperate enough to almost starve myself. None of it worked. None of it! I am thin on top and have huge tree trunk legs. Now I know why. I know liposuction is cosmetic; will this procedure be covered in order to treat a real medial issue that isn't cosmetic?

David Amron, MD · Answer

Lipedema is definitely a very real condition and a disease, but sadly it is not recognized by most, if not all, of the insurance carriers. It still amazes me that gastric bypass surgery is now covered by insurance, but lipedema surgery is still commonly not covered. Hopefully in the future that will change with increased awareness and the decrease of ignorance regarding lipedema. The reality is, that at the present time it is certainly a challenge to get coverage by insurance carriers. The preferred treatment is a specialized surgery called lymphatic sparing liposuction, that needs to be approached in a very particular fashion as these are not your typical liposuction surgery cases. The surgeon should have an experienced understanding of lipedema. There are factors with regard to pre and post surgical care that differ from typical cosmetic liposuction surgery. We do feel there is hope of getting these surgeries covered by insurance, the victories are few and far between especially in mild cases such as stage 1 lipedema. With that said, I have seen some stage 1 patients with symptoms of pain get some reimbursement coverage. My recommendation is to build the best evidence to make a case for yourself with your insurance carrier. It is not enough to just see a surgeon like myself, it helps to see other physicians that support the diagnosis and recommend surgery for lipedema. Lipedema patients commonly have orthopedic issues, and if a patient sees an orthopedic surgeon that recommends this type of surgery for treatment, this would be an example of support that insurance companies look at which can increase the chances of any type of insurance coverage. I also recommend, if possible, to see a lipedema diagnostic specialist such as Dr. Karen Herbst or Dr. Emily Iker to add support to your diagnosis and recommended treatment plan. I know first hand how challenging this can be as of today, but hopefully that will change as time goes on and we continue to raise awareness about this real disease. I wish you the best of luck.

Vincent N. Zubowicz, MD · Answer

The term lipedema is entered the vernacular but is not a true medical condition. Liposuction is cosmetic and is not covered by insurance.

John L. Burns Jr., MD · Answer

This would require consultation with a plastic surgeon who would then submit a letter to your insurance company with the diagnosis and treatment plan.  In general, insurance would cover medically necessary or functionally impairing conditions.  A lot would depend on what type of insurance plan you have.

Nagi T. Ayoub, MD, FACS · Answer

I am sorry to hear about your diagnosis of lipedema.Liposuction may be an option for you.  Unfortunately insurers consider liposuction a cosmetic procedure and most plans do not cover liposuction even got medical conditions like lipedema.Nevertheless it does not hurt to check.  You can do yourself by calling the eligibility number on the back of your insurance card.  I I hope that this answear helped some. Good luck.

Benjamin Van Raalte, MD · Answer

Liposuction is a cosmetic procedure. It is not covered by insurance. Checking with your insurance in 2015 is not a good option. Pre-approval and guarantee for payment are two completely different processes. In 2015 the clerks are now told do say carefully worded answers. They do not want to make a mistake and misunderstand a cancer and tell the patient it is not covered and the patient sues because they did not get treatment for cancer. Then it is reviewed prior to payment and denied. Then the patient owes the exorbitant hospital facility fee which can be ten of thousands. We have several denials of pre-approved breast reductions. So be careful.

Tom J. Pousti, MD · Answer

I am sorry to hear about the problem you are experiencing.  Unfortunately, online consultants will not be able to predict with any reliable degree of accuracy whether your specific health insurance policy will cover surgical treatment. Best to check directly with your insurance company to see whether breast reduction surgery is a “covered” benefit with your specific policy.   Generally speaking, patients who are  looking for help from insurance companies will potentially need to be persistent/patient. Best wishes.

Mats Hagstrom, MD (license on probation) · Answer

I think you answered your own question when you stated that liposuction is not covered by insurance. Lipedema may have a medical term, and it may be progressive. Still, it does not cause impairment other than body disproportion.  The key to getting medical authorization is to create the correct diagnosis code. The diagnosis cannot be body shape. For example, large breasts have been proven to cause neck and back pain. The diagnoses that allows breast reduction surgery to be covered is not large breasts but rather neck and back pain.  Similarly, removing loose skin from the lower abdomen after weight loss is not covered by a diagnosis of loose skin. The procedure is covered by a diagnosis of a skin infection. Because lipedema rarely causes these types of diagnoses, the procedure is not covered.  If you could prove lipedema causes pain and that pain is relieved by liposuction, then insurance companies would be pressured to approve the procedure. Perhaps someday they will, though I do not believe it will in the near future. On top of this, you are now at stage one. Your body disproportion may be quite a concern for yourself, though there are many people who have much worse disproportion without the diagnosis of lipedema.  The denial of insurance authorization for plastic surgery procedures is equally frustrating for the providers. We simply try to explain our experience to outside agencies over which we have little control. Considering that medical health insurance is becoming so expensive, it is often out of the reach of many working people. There is also a real need to contain costs. Talk to a board-certified plastic surgeon to see if you're candidate for surgical intervention and what it would entail.Best of luck,Mats Hagstrom, M.D.

Will insurance cover liposuction for my lipedema? (Photo)

Answers (7)

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