2022 was another exciting year for lipedema insurance coverage. Coverlipedema.com continued to leverage our success from the prior three years to expand safe, effective, and fully covered lipedema surgery. We continued to overcome the challenge of greedy insurance companies and selfish lipedema surgeons to get lipedema patients the medically necessary surgery that they deserve.
More Lipedema Surgeries Covered
Last year, we helped over 70 women get their lipedema surgeries covered, bringing our total to nearly 400 women who have their surgeries fully covered. We are so confident that we can get our members covered in a few months for their surgeries through most commercial insurance companies that we guarantee we will assist you until you are covered as a part of the Coverlipedema.com Guarantee. While Medicare and Medicaid coverage remains especially difficult, we have also developed strategies to get coverage with those insurers.
Insurance Companies Continue to be Difficult
No other disease has the support and advocacy that Coverlipedema.com provides for lipedema. This effort is necessary because although many insurers cover the treatment of this disease, they do not fully support their coverage policies. They seem to continue to fear the number of women who have lipedema and the potential cost of treating them. Most insurance companies do their best to keep their policies hard to find and poorly publicized. They do not train their staff on lipedema coverage. So, calling customer support numbers often leads to wrong answers and confusion. Many insurance companies seem to want women to think they must pay cash upfront for surgery and seek reimbursement later, which only benefits the insurance company. Over the past year, we have labored steadily to overcome these challenges for all women suffering from lipedema. A considerable amount of our time is consumed by ensuring that our members get the full coverage promised in their coverage policies. Although we have seen many new ways that insurance companies are trying to restrict the medically necessary treatment of lipedema, we have continued to be highly effective in getting our members covered with the surgeon of their choice.
The Breakdown of Covered Members by Insurance Company
Overall, the numbers have not changed since last year. We had hoped to increase the number of women we covered. However, several factors kept our new coverages at the same level, including surgeons who were fully booked, other surgeons who were experiencing issues with certain insurers, and some insurance companies who changed their willingness to cover lipedema. Most notably, we found the unwillingness of Aetna to work with surgeons who don’t require payment upfront and want to perform surgery in hospital settings a hindrance to safe and effective coverage. Fortunately, a surge in approvals with various Blue Cross Blue Shield companies offset this problem. This past year has shown us that the rules of lipedema insurance coverage change frequently. What worked two years ago didn’t last year and certainly won’t work this year. Fortunately, we have been able to adjust our strategies to get women covered.
|Insurance Company||Members Covered|
|UnitedHealthcare and UMR||
Healthcare Service Corp (HCSC)
(Blue Cross Blue Shield of TX, IL, OK, MT, and NM)
|Other Blue Cross Blue Shield Plans||
|Federal Employee Plans||
|Medicare and Medicare Advantage||
|Other Insurance Plans||
We Have Made Our Coverage Process More Affordable
To make our services accessible to more women, we have worked to make our Coverage Process more affordable. When we started last year, the fee was $500, then we lowered it to $399, and then to $299 in September as a short-term trial. The $299 fee was so popular that we decided to make it permanent. Aside from lowering our fee, we have found other ways to lower the cost of getting approved. Although we highly recommend a functional evaluation to support coverage requests, we had been uncomfortable with the cost of the exam that we originally developed with the assistance of another provider. The provider of that exam usually charged $500 or more to conduct the test and it could only be completed by certain examiners. Moreover, the provider was not willing or able to bill insurance for the exam. To benefit our members, we completely redesigned and streamlined our evaluation. It can now be easily completed by any physical or occupational therapist who can easily bill insurance for the service. Now, most of our members have little or no out-of-pocket cost for their lipedema physical exam. We are also trying to lower the cost of getting additional diagnoses. We do our best to recommend in-network or low-cost physicians for diagnoses. Because of the limited number of clinicians who can diagnose lipedema, many of our members have had to travel long distances to get a proper non-surgeon diagnosis. We have worked on expanding the list of clinicians who we recommend for diagnoses. We now have over twenty non-physician experts around the country and are adding more. We hope to create an accessible list of providers nationwide for our members.
We Won Many Appeals Last Year
We have continued to be successful in appealing denials this year. The average amount of covered surgery is over $70,000. Hospital stays are always covered, but sometimes patients need to win full coverage by appeal. We encourage women to sign up when they begin their coverage journey and not wait until they are denied before coming to us. The appeal process is fraught with issues, and we must work hard to ensure fair reviews. Fortunately, only about a third of our members must go through an appeal process to address coverage issues. Sometimes appeals are decided internally by the insurer, but other times members must go through an external review. We were able to get Blue Cross Blue Shield of Alabama to cover care without an external review, but we are seeing more partial denials from Anthem and Aetna involving the arms or the trunk. We also worked with states and employers to ensure fair reviews with qualified reviewers. We have been challenging several poor-quality physician reviewers that we have tracked and have had some insurers and employers step in to ensure a higher-quality review. The data we keep on reviewing companies and overturned reviews, combined with our continuously updated appeal documents and attachments, is more than worth the $875 we charge for this process. Our specialized advocacy makes our appeal process even more successful in ensuring safe, effective, and fully covered lipedema surgery.
Our Focus is on Access
At this point, if you follow the Coverlipedema.com Coverage Process, you will get covered. We guarantee it! However, there are currently only ten plastic surgeons in the United States treating lipedema safely and effectively with insurance coverage. In most cases, we can get you to the surgeon of your choice, but we recommend staying as close to home as possible to increase your chances of coverage and for post-operative safety reasons. Currently, about half of our Coverlipedema.com members who choose to use a non-network surgeon need additional help from us. We secured dozens of network exceptions this year, which paves the way for the insurer to enter into a one-time contract with surgeons and treat them as if they are in network, so full payment upfront by the patient is not required. We have worked with over 70 of the Fortune 500 companies, all major airlines, many banks, hospitals, and unions to ensure that women who are covered have access to a qualified and safe surgeon. We never leave our members without a surgeon and, in some cases, have helped them transfer to a network surgeon, including at least one who is not public about treating lipedema.
More Plastic Surgeons for Safe, Effective, and Fully Covered Surgery
We published considerable education last year about the importance of working with a plastic surgeons and how women can be confused by some lipedema surgeons’ marketing and social media. We also started to reach out to plastic surgeon societies. Our goal is to double the number of recommended plastic surgeons treating lipedema this year, so women have options closer to their homes and surgeons will be available sooner. Plastic surgeons have years of training in reconstructive surgery and perform surgery safely in a hospital. We are picky about who we recommend, and they must be willing to do larger volume liposuction (at least seven to nine liters) while using overnight hospital stays. They should not be interested in lipedema just as a business opportunity but as a disease treatment. Of course, we have continued to find more surgeons this past year. We have added Drs. Kim, Elston, Schaffner, and Domanski to our list of recommended lipedema surgeons. We also spent a significant amount of time ensuring that both network and non-network surgeons are paid fairly by insurance companies, so they continue to be willing and able to treat women with lipedema.
We are Excited about the Opportunities of 2023
We have come a long way over the past four years we have worked with lipedema insurance coverage. We have helped almost 400 women get over $40 million covered by their insurance. Our mission is to make insurance companies treat lipedema like any other disease so our services will no longer be needed. We will continue to focus on the areas of advocating for for fair coverage of safe lipedema surgery, educating about the insurance coverage process, and helping patients choose surgeons, while working to expand coverage policies and to find more board-certified plastic surgeons to perform lipedema surgery. As we begin our fifth year of lipedema insurance advocacy, we are excited about the opportunities ahead in the next year to accomplish our mission.
Have a safe and healthy New Year!
The Staff at Coverlipedema.com