Lately, we have seen new groups on Facebook offering advice on insurance coverage. While we are happy to see the awareness of lipedema grow and hopeful that all women who suffer from lipedema can find relief, we want to caution our members about the quality of advice offered on some of these groups. When seeking advice about insurance coverage, make sure you deal with a person who has the knowledge and experience to help you. So many of the lipedema support groups are filled with women who failed to get properly covered, advising women who don’t know how to get covered. We see so much misinformation and bad advice. You have to be careful not to waste your time.
A Few Things to Know
You have to know who is giving you advice. So, ask anyone who offers you advice how many women they have gotten covered. Ask about the dollar amount of coverage they have helped obtain. Also, ask them how many insurance companies, state regulators, and lipedema surgeons speak with them regularly. Let them tell you about their healthcare advocacy training and experience. When they claim that they were fully covered for their own surgeries, ask them to share the explanation of benefits that shows those payments. Ensure that they are working with the same surgeon you are and that they share your insurance plan. Otherwise, their experience might not apply to you. And one last thing. If the person offering to help you seems to be an extreme fan of their surgeon, be very suspicious of their bias. After you get answers to these questions, you should ask yourself, “Is this someone who can help me?”
What Really Matters
Knowledge and experience matter. It’s one thing to get $8,000 reimbursed for a stage one surgery of legs only, but entirely another to get $100,000 for several surgeries for arms, legs, hips, and abdomen fully paid in advance with an out-of-state, out-of-network surgeon. While we appreciate that women want to help others get covered, uninformed and incorrect opinions can be very damaging to your coverage request. Mistakes made in preauthorization can come back to haunt you months later in an appeal. Not knowing how to convince insurance companies and independent review organizations that you should be covered can lead to your denials. Frankly, harassing an insurance company online and threatening to sue them is not an effective coverage strategy. Paying in full upfront, just because someone says they did and were reimbursed a year later after several appeals is also not a wise strategy. Coverlipedema.com has helped over 300 women get tens of millions of dollars of safe lipedema surgery covered by insurance the right way. Our advice on how to get your surgeries fully covered is based on that experience combined with our training, ability, and contacts.