Frequently Asked Questions
Should I just let my surgeon handle insurance coverage and payment?
You must be proactive in your health care. Your success rate will be much higher if you are knowledgeable and involved in the process. A surgeon’s office manages care for many other patients and may not be able to give your coverage request sufficient attention. Additionally, there are other documents you need to gather like the functional capacity evaluation and the support for conservative measures.
Some surgeon’s offices are better than others at supporting patients seeking insurance coverage. When we review your plan, we provide guidance on this as well as letting you know which surgeons are open to making single case agreements with insurance companies.
To be frank, lipedema coverage is still in the early stages and it will be much more difficult for you or a surgeon to secure coverage and payment without our unique insight into the coverage, appeal and payment process.
How long does it take to get my surgery covered?
If you plan covers your surgery without an appeal it can take about six weeks to get approval. If you need to appeal your case, it could take as long as four months.
How much work is involved?
We make this as easy as possible for you. Most of the forms you need for getting coverage are provided. You will need to fill them in which should take a few hours and then coordinate with your surgeon to get supporting letters and office notes. We also provide draft letters that you can use to help the surgeons complete. Regardless of our efforts, you have to have a complete lipedema diagnosis and surgical plan before you can apply for coverage.
If you need to appeal a coverage denial and have done a good job with your documentation, it can take 4 or 5 hours to complete your appeal. We also provide tips on additional steps you can take with your employer or the independent review company to maximize your chances of winning your appeal.
If you have to dispute poor payment by a plan through a separate appeal that also can take 4 to 5 hours plus phone calls and emails to ensure that claims are processed and paid.
What is your success rate?
For half the patients who have plans that cover lipedema (Aetna, Anthem and many small plans including state blue cross blue shield plans) there is a 100% success rate. Sometimes these plans will mistakenly deny coverage and you will need to reach out to them, but most time is spent depending on the plan ensuring that they pay fairly especially if you see an out-of-network provider.
If you have to appeal your claim, you have an 80% chance of winning coverage on external appeal provided you have good documentation of your diagnosis, conservative measures and impact lipedema has on your function. We provide strategies to maximize your chances and can assist if you have a poor quality review.
How much can I expect my insurance company to pay for my surgery?
We have made amazing progress in getting lipedema surgery covered in the past 18 months. 80% or more of patients with documentation of their diagnosis, three months of conservative measures and a functional capacity evaluation can get coverage and payments for surgery ranging from $8,000 to $16,000 per surgery. Some plans pay better than others and how much you get paid can depend on your geographic location.
Can I get help if I need it?
Yes. We are available to help you and can answer simple questions via our contact form. For complex questions that require significant time and effort to answer, we offer consultations at the rate of $280 an hour billed in 15 minute increments. You can buy as many 15 minute increments as you need. Either way don’t hesitate to ask any question. Our mission is to get you covered and we are here to help you.
Please visit the information pages specific to your insurance plan for more information and then register and start working towards getting your surgeries covered!
Learn about Insurance
Please visit the information pages specific to your plan for more information on your insurance coverage.
If you have already reviewed your insurance information, click below to move towards getting your surgeries covered!