Liposuction is rarely, if ever, covered by medical insurance. The main reason for this is that there are few, if any, symptoms or diagnoses treated by liposuction that are considered medical. The key to understanding medical authorization for surgical procedures is to start with the diagnosis rather than the procedure. In your case, the diagnosis would most likely be pain and probably some type of skin problem, like a skin infection. Both skin infections and chronic pain are medical conditions that should be allowed to be treated in the most effective way. The problem is is that there's no published data showing that liposuction helps skin infections or chronic pain from pressure on genitals. Your primary diagnosis is obesity. There are medical interventions to help lose weight, such as gastric bypass. Weight loss should be the first and primary goal in your treatment plan. The typical treatment for skin folds causing medical conditions on the lower abdomen is called a panniculectomy. This is a procedure where the loose folds of skin are surgically removed. This procedure can be covered by insurance if certain criteria are met. It often requires a plastic surgeon to work diligently as a patient advocate to obtain authorization. It's possible that initial authorization may be denied, and appeals may need to be made. Secondary sets of information may need to be submitted, such as photographs, etc. All in all, this can end up taking many hours of time on behalf of the plastic surgeon and his or her staff. Most of this is not reimbursed by the insurance company. Also, consider that insurance reimbursement for these types of procedures is minuscule in relation to what most plastic surgeons charge for cosmetic surgery. A large panniculectomy may take four hours in the operating room and require a patient to be in the hospital for one or two nights. Reimbursement for these procedures is around $1,000. That's about half of what most plastic surgeons would get for doing chin liposuction, which takes about 30 minutes in the office.The reason I bring up these topics is not to complain about the low reimbursement from insurance or how much plastic surgeons make or should make. It's important for you to know so that you can put things in perspective. Some plastic surgeons may be willing to help you and will do everything they can to get this procedure covered by insurance while others may not be so interested in doing this type of work. Set up a consultation with a board-certified plastic surgeon. Consider multiple consultations if you don't find what you're looking for. The process of insurance authorization can be frustrating. It can be so for both sides. The key is to remember that insurance contracts are legal documents based on objective criteria. Again, the process starts with making the correct diagnosis and then finding treatment options that are proven effective to treat that condition. Another word of wisdom is the squeaky wheel gets the grease. This is often true when dealing with insurance companies. Documentation and persistence are often needed. Best of luck,Mats Hagstrom, M.D.
