Does Insurance Cover Lipedema Surgery?
Understanding Lipedema and Insurance Policies
Lipedema is a common disorder of painful fat distribution that affects millions of women. For this reason, health insurance companies such as United Healthcare have formal policies regarding liposuction for lipedema. Other companies such as Blue Cross Blue Shield Plans may not have any single policy document.
There is significant variation in policies. Some health plan lipedema coverage varies from state to state, or even from employer to employer!
The Importance of a Medical Diagnosis
We believe it is useful to obtain a medical diagnosis of lipedema from a provider who is not a surgeon. A diagnosis relies on a physical examination and review of medical history as there is no specific lipedema test that can either rule in or rule of this condition. You should be prepared to discuss family members with suspected or confirmed lipedema, age of onset of your symptoms, body parts affected, and whether weight loss helped reduce symptoms of lipedema.
Some insurance companies will require a physical therapy evaluation to determine physical impairment from lipedema. If a patient has the lipedema nodules present, but they do not limit the patient in any way, that patient will not have any impairment. Thus, impairment is defined as how a diagnosis impacts a patient’s life from a physical therapy perspective.
Conservative Treatment Requirements
Insurance companies will often desire a patient to attempt conservative treatment before surgery. If a patient attempts compression, a pump, or a vibration plate, and does not obtain relief, they may be a surgical candidate. Patients who have attempted manual lymphatic massage (MLD) and failed to obtain it may also desire surgery. The patient should keep documentation in the form of prescriptions, receipts, or clinical visit documentation to demonstrate that non-surgical options are not working.
Photographic Evidence
Pictures are important in securing coverage of lipedema surgery. The stigmata of lipedema should be clearly visible on photographs. We take these pictures as part of our examination in our office. Pictures are medical and focus on the body parts to be covered. For example, lipedema pictures of the arms should not include the face.
While stage 1 lipedema patients can have pain and impairment, insurance companies are less likely to approve treatment for a patient whose photographs do not demonstrate photographic evidence of lipedema.
Insurance Coverage For Lipedema Surgery & Medical Necessity
Lipedema is treated by liposuction and excess skin removal. As liposuction can also be considered cosmetic, it is important to build a case to an insurance company of the medical necessity of lipedematreatment.
Once a patient can build a case for the medical necessity for treatment of their lipedema, the supporting documentation is submitted to their insurance company. These documents often include:
- Medical records from diagnosing physicians
- Physical Therapy impairment evaluation
- Evidence of use of compression or a pump to demonstrate inadequate relief from nonsurgical measures
- A surgical plan from their surgeon.
There are lipedema advocates that specialize in assisting patients to obtain coverage from their insurance plans. At Bluemont Plastic Surgery, we have no financial relationship with any lipedema advocate. However, we have seen that patients who work with an advocate have greater success obtaining coverage.
Thank you for placing your trust in us. We hope that you are able to obtain insurance coverage for lipedema surgery through your insurance company and that we can be a part of your treatment.
