Conservative measures to treat lipedema include diets, medical weight loss, exercise,
compression, manual lymphatic drainage (MLD), pool therapy, Flexitouch, lymphatic
pumps, and vibration plates. If you want to have your surgery covered, it is essential to
document at least three months of conservative measures including compression or
manual lymphatic drainage (MLD).  This three-month standard was adopted by Anthem
and Aetna to support coverage of lipedema surgery and we apply them to other insurers as
well. It is important for your coverage request to show the failure of these conservative
measures whenever and however possible. It is reasonable to present documentation of
conservative measures in the two years proceeding your request for surgery coverage
if not immediately before if resuming treatment is not helpful or feasible.


Compression: 
It is preferable to have a physician order for any medical-grade compression garments and
devices that you used for at least three months. Some patients have submitted receipts for
compression that they just bought online and, thus far, those have been accepted. If your
insurer paid for compression, provide documentation of that coverage.


Manual Lymphatic Drainage (MLD): 
It is preferable to have a physician order for MLD therapy that you do for three months.
Sometimes, MLD is part of physical therapy. MLD therapists are usually willing to provide a
letter documenting your lack of progress with MLD. You can also highlight the notes or
make your own summary of MLD measurements to show a lack of progress. If you include
therapy notes, be mindful that therapists billing for services have to make statements that
you are improving. Also, be mindful of including notes that you are doing the therapy to
qualify for surgery. If your insurer paid for MLD, provide documentation of that.