2021 was an exciting year for lipedema insurance coverage lipedema. Cigna and United Healthcare finally settled their lawsuits and have issued coverage policies. In addition, many other insurance companies have also started covering and have released coverage policies. Although COVID may have slowed the pace of elective surgeries during the past year, we look forward to more opportunities for women to get relief from the pain and disability of lipedema in 2022.
We Have Refocused our Commitment
At the beginning of last year, we were committed to getting all women covered with all surgeons. However, as the year passed, we learned that not all surgeons were insurance friendly by our standards. We also learned that board-certified plastic surgeons are the best choice for fair coverage and safe surgeries in appropriate settings. As a result, we limited our advocacy to the patients of board-certified or board-eligible plastic surgeons who we believe present the best opportunity for the fair coverage of safe surgeries.
This year our focus will be on these five areas:
- Advocating for patients to have fair insurance coverage of safe lipedema surgery.
- Educating about the insurance coverage process and correcting misinformation.
- Helping patients make safe and effective choices of surgeons.
- Working to expand coverage policies
- Finding more board-certified plastic surgeons to perform lipedema surgery.
We Get Women Covered
When Coverlipedema.com members follow our process, we guarantee fair insurance coverage most of the time. While we have made great strides in getting insurance companies to cover, patients continue to face challenges. Unfortunately, lipedema insurance coverage is still not a do-it-yourself project. We caution members that Aetna has become more difficult lately and has even denied several women, requiring appeals. United Healthcare remains very stringent in its coverage requirements and doesn’t explicitly cover excisions of excess skin, although we have won that coverage on appeal. Overall, another 68 Coverlipedema.com members obtained coverage in the past year, including several Medicaid and Medicare members:
|Insurance Company||Members Covered|
|United Healthcare and UMR||6|
|HCSC (BCBS of TX, IL, OK, MT and NM)||8|
|Other BCBS Plans||10|
|Federal Employee Plans||3|
|Medicare Advantage and Traditional||5|
We Work on the Policy Level, Too
In addition to advocating for individuals, we also advocate for lipedema coverage on the policy level with state regulatory agencies and insurance companies. Our continued advocacy with small Blue Cross Blue Shield (BCBS) plans has resulted in policies for BCBS of Michigan and South Carolina, Florida (Florida Blue), and CareFirst (BCBS of the Maryland/DC area). Now, about half of BCBS insurers have lipedema coverage policies. In addition, in the past year, several other insurers covered lipedema for the first time without extensive appeals, including Horizon NJ BCBS, Humana, MVP Health Plan, and Capital BCBS.
Insurers like Cigna and Anthem, and to a lesser extent United Healthcare and Aetna, have pushed members to use their network surgeons, even if they are unqualified to perform large volume liposuction. We are concerned about this trend. We are planning more activism and media attention this year to encourage the insurers that settled their lawsuits to learn about lipedema and use qualified surgeons are in their networks.
We Have Found New Surgeons!
One of our main challenges is finding qualified plastic surgeons who operate in a licensed setting with appropriate post-operative monitoring. This year we added five surgeons to our list on Coverlipedema.com: Dr. Omar Beidas in Florida, Dr. Boris Volshtyne in New Jersey, Dr. Tomas Hagopian in Georgia, Dr. Andrew Berry in Kansas, and Dr. Andrea Martin in Chicago. We have also found two plastic surgeons in California, one in Minnesota and one in New Hampshire, who are all in-network, and an out-of-network surgeon in Texas who is insurance friendly. We have not yet disclosed the names of these surgeons, given how overwhelmed some surgeons have become when we introduced them to the lipedema community. We want to ensure that these new surgeons are fairly paid first by working with selected self-funded plans. We hope that we will make announcements later this year.
We Have to Correct Some Misinformation
Unfortunately, there has been some misinformation that we have a financial relationship with the surgeons we recommend. This is not true. We receive no money or services from the surgeons that we list on Coverlipedema.com. There are no finder’s fees, kickbacks, bribes, gifts, or payola. We recommend the surgeons for reasons that represent the best opportunity for our members to get fair coverage of safe surgeries. Not because they pay us in any way.
Our mission is for lipedema to be like any other disease, with qualified network surgeons able to treat the disease in a timely manner. There is so much misinformation on social media that distracts women from using insurance for safe lipedema surgery. While a few women might get lucky on their own, we get almost all of our members covered. We are confident that in 2022 we will get even more women covered for surgery with more qualified surgeons available to operate and more plans fairly covering surgery.
What Should You Do Next?
If you are a Coverlipedema.com member, you should continue to work on your coverage or appeal packages. Now is not the time to procrastinate. If you can get covered in the first quarter of the year, your surgeries will most likely take place this year. This will allow you to maximize your deductible and your out-of-pocket cost limits. This is especially true if COVID hospitalizations decline and elective surgeries are allowed to be scheduled.
If you are considering joining, you should join now to start working with us to get your surgeries covered. There are a limited number of insurance-friendly surgeons, so they are often booked several months in advance. Even with better insurers, you will need a few months to get everything together for your effective preauthorization. So, now is a good time to plan on getting your surgeries done in 2022 so you can leverage your coinsurance payments, deductibles, and out-of-pocket cost limits. Make an appointment on our website to speak with us. Schedule your free consultation with us today on our website with the link below.
If your surgeries have been covered by Coverlipedema.com, you should let everyone know how women can get their surgeries covered with the lowest out-of-pocket cost possible. Also, please take advantage of our Pay It Forward Program that gives you $50 for every person you refer to us who becomes a member up to $500. See details on our website.
Everyone should like our Facebook page, join our Facebook group and follow our Instagram to see the latest information about lipedema insurance coverage. Links for the Facebook page and Instagram are below.
For Your Best Opportunity for Fair Coverage, Always Remember:
- Choose competent network board-certified plastic surgeons who perform their surgeries in hospitals or licensed surgery centers.
- If you don’t have a network surgeon, choose only out-of-network surgeons who are board-certified plastic surgeons and who want to cooperate with insurance companies.
- Never choose a surgeon who requires that you pay-in-full upfront for lipedema surgery if you have insurance.
- Never choose a surgeon who requires that you pay-in-full upfront for lipedema surgery if you have insurance. (It’s not a mistake. We cannot repeat this often enough!)
If you have questions about lipedema coverage, please reach out to us. We are here to help you on your journey to health and wellness.
The Staff at Coverlipedema.com