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Insurance Coverage for Lipedema

Insurance Coverage for Lipedema

Patients undergoing lymph sparing liposuction procedure have always found the process of obtaining insurance to be a rather difficult process. Most medical insurance providers don’t see it as a surgical procedure that patients need to improve their appearance. Rather they see it for the most part as a cosmetic procedure. As such, they refuse to cover the majority of liposuction procedures. And while you can try to find your way around these restrictions, most of the time the language of the insurance policies makes it difficult for you to get insurance coverage for Lipedema.

Barriers to Medical Insurance Coverage for Lipedema

Unfortunately, under the US medical system, Lipedema doesn’t have a specific code. And since the insurance providers rely on the International Classification of Diseases to give codes to diseases, this leaves Lipedema without a code or classification. And without a specific code, insurance companies choose not to recognize Lipedema as a medical disease.

Another problem that makes insurance providers balk at offering insurance for this procedure is that most of the studies which show the effectiveness of the treatment were published in Europe. And even though many American surgeons perform the procedure for Lipedema, not enough studies have been published in the United States. Without the studies, and despite the effectiveness of the procedure, the medical reviewers refer to it as “experimental”.

The Insurance Approval Process

It’s important for you to read through the language of your insurance coverage policy. If you find something like “no liposuction for any reason” this means your insurance provider will not pay for the procedure and there’s nothing you can do about it.

Another thing to look for is “out-of-network” benefits. This might require you to pay a higher percentage of the procedure cost. So check with your insurer about your benefits and how much you’d be expected to pay out of pocket when you look into insurance coverage for Lipedema.

Once you have submitted your insurance application, you need to wait for approval. If your application is denied and if the denial isn’t an administrative denial, you can appeal it. A process which could take between 4 to 12 months. You can submit your final appeal to your State Board of Insurance and you have to do it yourself. If you win the appeal, your insurance provider will be forced to cover your procedures.

Our office helps you get pre-authorization or pre-certification for lymph sparing liposuction surgery. Dr. Wright will talk with the medical director from your insurance provider and will speak on your behalf at the state independent reviewer hearing.