The settlement of the lawsuit against UnitedHealthcare (Mary Caldwell et al. vs UnitedHealthcare et al.) was finally approved after four years. We attended the settlement conference and provided testimony on November 28 in San Francisco. We were advocating on behalf of three of the plaintiffs, who are Coverlipedema.com Members.
What the Settlement Means for the Plaintiffs
The 28 plaintiffs of this class action were initially denied coverage of their liposuction based on the treatment being unproven for lipedema. They finally have the opportunity for their requests for coverage to be approved and to submit claims for any liposuction for which they have already paid. The settlement only includes liposuction, not skin excisions or other standard lipedema treatments. For the plaintiffs in the class action who have not had surgery yet, even if they no longer have UHC insurance, UHC is supposed to enter into an agreement with a surgeon for liposuction to treat their lipedema. The surgeon can be a new surgeon, not only the surgeon initially denied since many safer and more effective plastic surgeons are now available nationwide. UHC is not supposed to apply any other criteria and should approve a surgery plan and provide enough time to complete the surgeries.
Advocacy Beyond the Settlement: Coverlipedema.com’s Commitment to Patients
UHC should pay the total amount of the surgery, but the settlement terms are vague. In our experience, insurance companies exploit vagueness in rulings. If any of the plaintiffs want additional advice, Coverlipedema.com will offer that advocacy for free, given that we have helped hundreds of women be paid fairly. We can also help them obtain full coverage for skin excisions or other treatments their lawyers failed to cover by the settlement. We have much more experience advocating for patients for insurance issues with lipedema than the law firm representing the plaintiffs in this case. If you are a plaintiff, email us through our contact form at coverlipedema.com to discuss further.
Safety and Effectiveness are Still Primary Considerations
We are concerned the plaintiffs may feel compelled to use surgeons who do not safely and effectively operate in a hospital setting. Keep in mind some lipedema surgeons, besides being less safe or effective, demand cash upfront and may do so from the plaintiffs. Also, a proper overnight observation stay is recommended for safe large-volume liposuction, and UHC should also pay for that. UHC could balk at a plaintiff requesting a non-network surgeon and any ridiculous amount they request to be paid for their services and self-owned “surgery center.” We have helped hundreds of women get to non-network surgeons without paying cash upfront and are happy to help at no charge. We also can advocate for plaintiffs to get consultations with board-certified plastic surgeons with extensive lipedema experience who might seem impossibly booked but are willing to work with women who have approval through this settlement.
Moving Forward: Empowering Lipedema Patients to Make Informed Decisions
We want everyone to have access to safe and effective plastic surgeons for lipedema surgery. We are concerned that the attorneys in this case, who are compensated based on the surgery cost, will recommend less safe and effective surgeons, including those in Los Angeles with whom they have existing relationships and who have a history of overcharging for their services and facilities. In the end, if the plaintiffs have overpriced, unsafe, and ineffective surgeries, the only winners of this lawsuit will be lawyers and greedy surgeons. We are committed to ensuring that this settlement promotes the cause of safe, effective, and fully covered lipedema surgery for all women who suffer from lipedema.