Our focus at Coverlipedema.com is to ensure lipedema patients have a timely, safe, and fully covered surgery. During the first quarter of this year, we have continued to advocate for individual insurance coverage, educate on the insurance process, correct misinformation, and encourage policy changes. We have also helped women choose safe and effective surgeons while searching for more qualified physicians to diagnose and insurance-friendly surgeons to treat lipedema. We have helped 300 women cover their surgeries, and we still believe in the effectiveness of our preauthorization, appeal, and network processes.
Social Media Criticism
Recently, we have encountered some criticism about our approach on social media. The complaints center around our failure to work with several surgeons who seem to have a solid fan base. These fans cannot understand why we will not work with their favorites, so they attack us for various frivolous or unfounded reasons. We are not surprised by these annoying attacks because we have disrupted the business of lipedema surgery. A few years ago, a few physicians, some qualified, some not so qualified, performed lipedema surgery. At that time, no insurance company covered liposuction since it was deemed cosmetic, unproven, or experimental. As a result, all lipedema surgery was cash-based. Because they were the exclusive providers of this service, many of these physicians built huge fortunes treating lipedema. However, times have changed. We, in part, have disrupted lipedema coverage. Now, most insurance companies fully cover liposuction for lipedema. Many qualified plastic surgeons perform lipedema surgery. Women who suffer from lipedema are no longer forced to pay inflated prices. They have a choice of properly trained surgeons who safely operate in licensed facilities following guidelines designed for patient safety, not just for profitability. We are proud to be a part of making this happen. So, we’ll suffer whatever criticism that may be leveled against us. Our response is to keep helping women get their safe surgeries fairly covered.
We have been working hard to find more board-certified or board-eligible plastic surgeons who have an interest in treating lipedema safely and effectively. We are now working with surgeons performing large volume liposuction safely in a hospital setting in Washington, Northern California, Arizona, New Hampshire, and Texas. Because of the issues involving Dr. Bedias being overwhelmed with new patients and Dr. Hagopian needing to pause to ensure fair payment by insurers, these new surgeons do not want to be publicized. They are currently only working with Coverlipedema.com members to ensure that their patients will be fully covered and they will be fairly paid for their surgery.
Insurance Coverage Overall
Although we have encountered many new ways that insurance companies have been trying to avoid covering lipedema surgery, we continue to be successful with our coverage, appeal, and network efforts. We also continue to win coverage for panniculectomies directly or through a quick appeal. Most insurance companies cover lipedema surgery, but they will only cover medically necessary surgery requests that are well supported with proper documentation.
Aetna continues to cover but is now often denying coverage for areas like the trunk and skin excisions. Aetna has also been refusing to contract with out-of-network surgeons after approval. We will need to involve either state regulators or employers after women are approved to ensure fair coverage. We have done that with all the big insurance plans several times, so we are still confident that we can compel Aetna to cover medically necessary procedures fully. So, if someone says they got easily covered with Aetna, it was either last year, or they just got lucky (which does happen). Unfortunately, Aetna used to be one of the best insurers for lipedema.
United Healthcare (UHC) continues to cover based on its strict policy issued last year. We have overturned a UHC denial of skin excisions for the first time. We have also won the first full limbs and trunk coverage for a UHC member, but UHC remains problematic at every stage requiring our constant advocacy.
Blue Cross Blue Shield
Many Blue Cross Blue Shield (BCBS) plans cover lipedema surgery. BCBS of South Carolina, BCBS of Vermont, Highmark in Pennsylvania and Excellus in New York have covered this year, but they have required care to ensure fairness. Florida Blue has established a new policy, but members could be subject to strict scrutiny at any time. We have helped several women with Federal BCBS get fully covered for Drs. Bedias, Hagopian and Gutowski. We have also won another appeal against BCBS of Alabama.
Cigna is approving decently now though we worry they are currently approving a few women due to their lawsuit settlement, but then will start denying all or parts of surgery. This is a behavior that we have seen with other insurance plans. They will cover just enough cases to show that they are trying to cover but not actually cover every medically necessary case.
Other Insurance Companies
We also had a first-time approval for Ambetter, which is related to Centene and HealthNet. We also had a second approval for the MVP health plan in New York. We also continue to assist members of union, employer, and hospital-based plans to have their surgeries covered.
Out of Network Agreements
Single case agreements that give our members the benefits of network coverage with out-of-network surgeons remain challenging. We can get our members to the surgeon of their choice most of the time. In other cases, we can get them to a backup surgeon. Horizon Blue Cross Blue Shield signed their first single case agreement with Dr. Boris Volshteyn in New Jersey, who has done several agreements with Aetna. We completed single case agreements for women to travel to Chicago for surgery who had Humana, MVP, and Premera BCBS. Humana and MVP were first-time approvals for liposuction of arms, legs, and trunk plus panniculectomy and excisions. This was only the third time covering for Premera.
Both Medicare and Medicaid have proven to be very poor payers of lipedema surgery. As a result, it is almost impossible to find qualified surgeons willing to work these insurance plans. Although we are currently working with several Medicare patients, we will not be accepting new members who have Medicare, Medicare Advantage, or Medicaid. We hope that this is only temporary. We’ll post updates on our blog and social media about this issue.
Insurance companies are not consistent with coverage even when they have a policy. Sometimes, they quickly cover, and sometimes they unreasonably deny coverage. Because of that, you may have heard that women have been covered without our help. However, we still believe that our processes are the best way to ensure that women can have their surgeries fairly and safely covered. Insurers do not properly train the clinicians who review your preauthorization request, so having a proactive package that addresses any concerns that have come up in the past is essential to facilitate coverage. Because we work nationally with patients, surgeons, and insurance companies, we constantly update our guidance to stay one step ahead of denials. In many cases, we also reach out to insurers directly for our members to enable timely and fair processing and to resolve issues without lengthy and expensive appeals.
For Your Best Opportunity for Fair and Safe Coverage, Always Remember:
- Choose a board-certified plastic surgeon who is in your network.
- If you don’t have a competent network surgeon in your network, choose only an out-of-network surgeon who is a board-certified plastic surgeon and wants to cooperate with insurance companies.
- Never choose a surgeon who requires that you pay upfront for lipedema surgery.
- Confirm that your surgeon operates in a hospital or licensed facility and follows proper post-operative observation recommendations.
If you have questions about lipedema insurance coverage, please reach out to us. We are here to help you on your journey to health and wellness.
The Staff at Coverlipedema.com