Will insurance cover liposuction for my lipedema? (Photo)
Doctor Answers 8
Insurance Coverage for Lipedema Surgery
Indication for medical authorization
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.
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Liposuction is considered cosmetic
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.
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.
Insurance to cover liposuction
- Most health insurers regard liposuction as cosmetic and will not cover it.
- You would need to contact your insurer to see if this is true for yours.
Hope you found this answer helpful. Best wishes.
Will insurance cover liposuction for my lipedema?
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