Why Join the Lipedema Coverage Connection?

Lipedema Surgery Is Expensive

A series of staged lipedema surgeries can cost over $100,000. Although most insurance companies cover surgery, they are not going to pay for them easily, especially when they think patients are trying to get free cosmetic or weight loss surgery. Insurance coverage is challenging. Women on social media who say just fill out a few forms and your surgeries will be covered are wrong. Some surgeons say insurance coverage is easy but make patients pay in full upfront instead of using their “insurance experts” to get themselves paid. And the way insurance works, patients who pay first usually face only partial reimbursement because despite having coverage policies, the insurers have not updated the fee schedules for liposuction so payment rates reflect small skin flap procedures not 3-5 hours of surgery. Paying out of pocket is not a good idea unless you have exhausted all insurance options.

Lipedema Surgery Coverage Is Difficult

A few years ago, major insurance companies, including Cigna, UnitedHealthcare, Aetna, and Anthem were sued for not covering lipedema surgery. They settled their lawsuits which helped a few dozen women. Although they issued coverage policies, these policies are not required as part of the lawsuit and they can and have issued restrictions. However, most Blue Cross Blue Shield plans have also issued policies but only to also avoid being sued. Not much effort has been put into understanding the disease and educating staff on the coverage and access issues.

Doing this on Your own is Risky

Although you can find information online about the coverage process, insurers are very picky and we have seen them deny surgery because some small thing is missing in an exam note. The information the LCC provides comes from seeing women approved and denied every day. We are there to answer questions and to review not just your package before it’s submitted, but also analyze your individual plan document and provide supplemental information that could make a difference in being denied, partially covered or fully covered.

Before your package is submitted, we assist you with engaging the insurer, regulator or employer. We also follow-up if the decision is inadequate so you can maybe avoid risky appeals. Although appeals are included in the membership and we sometimes need them, the LCC process is designed to avoid them as reviewers often do not understand the disease and some are even actively hostile to lipedema patients and surgeons. Lastly, most surgeons that treat lipedema and not in-network with insurance. Getting a network exception and agreement directly with the surgeon so you do not pay cash upfront is fraught with issues and challenges that the LCC can help you navigate.

The LCC Services are Vital

The LCC serves as a vital bridge between lipedema patients, plastic surgeons, and insurance companies. Our experienced team, with a background in payment law and healthcare advocacy, has been advocating for patients with insurance companies for over 20 years. Our commitment to obtaining the best treatments covered by insurance is driven by our personal connection to the disease—women in our family have been affected by lipedema.

The LCC provides professional advocacy services for women seeking coverage for lipedema surgery. Our team of experienced advocates guides members through creating effective coverage requests, appeals and network exceptions. Members gain access to extensive resources, including contacts at the highest levels of insurance companies and state and federal regulators, as well as non-surgeon lipedema expert clinicians nationwide. Throughout the process, our advocates answer questions, review requests, and ensure fair coverage decisions in the best interests of our members.

Your Next Step

Learn how to join and how much it costs.