Information for Plastic Surgeons
About Coverlipedema.com
Coverlipedema.com advocates nationally for lipedema patients. Over the past six years, we have worked with hundreds of patients to help them get their lipedema surgeries covered fairly by insurance. We have accomplished this with all the major insurance companies and with many highly regarded plastic surgeons. Our efforts have spanned from individual advocacy to state and federal policy change. As time has passed, we have focused on ensuring safe, effective, and fully covered lipedema surgery. To do this requires connecting with capable and ethical plastic surgeons interested in lipedema surgery, not only as a profitable business but also as a calling to help alleviate the suffering and disability of this disease. We are currently working with over thirty highly-qualified plastic surgeons, fifty diagnosing clinicians, and we have advocated for the coverage of almost 1,000 patients for their lipedema surgery.
Plastic Surgeons on Why They Treat Lipedema
Lipedema Is a Widely Recognized Disease
The Mayo Clinic first recognized Lipedema in the 1940s. This adipose tissue disorder results in fatty deposits under the skin of the limbs, hips, buttocks, and lower abdomen. It’s linked to hormonal changes such as puberty, childbirth, and menopause.
The disease often runs in families. Studies of fat cells have found lipedema to be more fibrotic and to have more activated macrophages. Women often complain of pain when a child or pet sits on their lap. It might be hard to keep up with peers in the early stages when doing normal activities such as hiking or biking. In later stages, women have severe issues with walking and may have to use assisted devices.
Insurance Companies Cover Lipedema Surgery
A few years ago, many major insurers were sued for not covering lipedema surgery, including Cigna, United Healthcare, Aetna, and Anthem. These insurers have settled their lawsuits and have issued coverage policies. In the interim, most smaller BCBS plans have also issued policies or have consistently covered the surgery. Humana, Tricare, Medicare Advantage, and some Medicaid plans also have covered lipedema surgery.
Most insurer policies explicitly cover liposuction on the limbs, buttocks, hips, and lower abdomen. Many policies also cover skin excisions on the arms, hips, thigh, and buttocks to address excess skin after surgery. We also regularly get insurers to allow women with lipedema without weight loss or hernias to have a panniculectomy rather than liposuction if the lipedema in their lower abdomen is severe.
Lipedema cannot be controlled with compression or manual lymphatic drainage, unlike lymphedema. Insurers recognize that and usually only require a three-month trial of conservative measures before surgery can be requested.
We Make Accepting Insurance Easier
We make it easy to accept insurance for medically necessary lipedema surgery. We assist with:
- Preauthorization
- Appeals
- Network Issues
- Fair and timely payment
We reduce the time and effort of office staff involvement with no cost to surgeons.
Who is Coverlipedema.com?
Coverlipedema.com provides an important liaison between lipedema patients and lipedema surgeons. The Coverlipedema.com principals have a background in payment law and health care advocacy. They have been advocating for patients with insurance companies for over 15 years and started working with lipedema after realizing that family members had the disease. We have encouraged many insurers to adopt coverage policies and have connections with insurer companies, large employers, and regulatory agencies.
Coverlipedema.com is a membership website that guides women through the process of creating effective coverage requests for their surgeries. We have helped over 600 women get fully covered. Ensuring that surgeons are fairly paid is central to what we do, and we work with both network and non-network surgeons. Insurers know there is a lack of qualified surgeons and that patients have resorted to non-surgeons like OBGYNs, vascular surgeons, dermatologists, cosmetic surgeons, etc., who advertise heavily and operate in unlicensed settings, often not following the America Society of Plastic Surgeons (ASPS) liposuction guidelines.
Our recommendations of surgeons who can provide safe, effective, and fairly covered surgery are one of the most important benefits of our services. Our members highly value these recommendations.
Coverlipedema.com is careful about who we allow to become a member. We only work with patients who have a reasonable opportunity to be covered for their surgery. We don’t simply accept everyone’s money and then apologetically shrug our shoulders when they are not covered. To ensure their coverage, we guide them through the process of creating an effective preauthorization package. We also work with our members through appeals and network issues if necessary. We relieve surgeon’s practices from this crucial but complicated and time-consuming work.
How Much Do Insurers Pay for the Surgery?
Insurers pay well for lipedema surgery. On average, professional fees are $20,000 per procedure (e.g., liposuction of the posterior legs). Some surgeons who perform higher-volume liposuction will combine procedures and can be paid up to $30,000 per surgery. Insurers also pay reasonable facility fees for surgery centers and hospitals.
Non-network surgeons who have worked with lipedema are comfortable doing single-case agreements with insurers for a series of surgeries set forth in advance. Surgeons are not obligated only to accept insurance for payment. For patients who desire to pay cash for their surgeries, hospital stays can be covered, and depending on the type of plan they have, we can work with patients to be fairly reimbursed later.
Because most lipedema patients have multiple surgeries, treating just 25 could lead to additional revenues of over $850,000 in either non-network surgeon fees or facility/professional fees for network surgeons.
What Additional Resources Do Surgeons Need to Treat Lipedema Patients?
Patients who are members of Coverlipedema.com are guided step by step in gathering the materials necessary to request coverage and prevent the need to appeal. We provide surgeons with a template exam note, letter of medical necessity, and coding recommendations needed to create a basic surgery plan.
Patients also support their request by having a non-surgeon diagnose them (from a list of physicians we provided) and by having an independent physical assessment developed to demonstrate the effect of lipedema on patients. The Coverlipedema.com website also assists patients in creating a cover letter that addresses the coverage requirements and helps them properly document their conservative measures.
After a patient receives their coverage determination, Coverlipedema.com helps them request a network exception, if necessary. In all cases, especially with the initial patients for each insurer, Coverlipedema.com assists the practice in negotiating a fair single-case agreement or, for network providers, a carve-out rate if the rate is inadequate. Once rates are negotiated, the insurers tend to stick with those rates, so starting with patients with self-funded plans that pay better makes sense. We have extensive examples of fair payment rates and high-level contacts at most insurers.
If there is a single case agreement, submission of claims is not complicated, given the limited number of codes and agreed-upon rates.
Surgery Benefits Lipedema Patients
Lipedema impacts at least one in one hundred women. It can be incredibly debilitating, but removing diseased tissue through liposuction and excision has been shown to be effective at controlling pain and improving function for many years.
Lipedema patients are very grateful for the treatment that allows them to play with their children and grandchildren, be active, and live normal lives. Because of the demand for treatment, you will not have to market your lipedema services after completing a few cases.
How do I Work Work with Coverlipedema.com?
Contact us by using the form below to set up a time to talk further about how you can work with Coverlipedema.com to develop your lipedema surgery practice. We can also connect you with surgeons treating lipedema, including Dr. Karol Gutowski, who wrote the ASPS safety standards on liposuction and has treated over 500 patients. The surgeons we work with are happy to answer any questions that you might have about treating this patient population.