How it works
We created Coverlipedema.com to provide patient advocacy with a high level of lipedema insurance expertise for an affordable cost for women who need to have lipedema surgery. We accomplish this by showing our members how to create effective coverage requests, determination appeals, and network exception requests. Following the steps of our process, you will put together the necessary parts of your coverage or appeal packages with the cooperation of your surgeon and other doctors. We devote our time to answering your questions, reviewing your materials, and handling the inevitable issues that only experienced and knowledgable advocates can handle. This approach saves our members hundreds, if not thousands, of dollars of advocacy fees.
You have to be prepared to commit some time and effort
Once you become a member, you will have access to a step-by-step process called the Coverage Process™ that you will use to create an effective coverage request package that has been proven to obtain insurance coverage for lipedema surgery for over one hundred women with many different insurance companies. You will also be able to gain access to our Appeal Process™, if you need to appeal a full or partial coverage denial and to our Network Process™, if you need to obtain an out of network exception.
What You Do:
- Create a powerful coverage request package designed to overcome all the common reasons for denial so you minimize the need for a lengthy appeal
- Ensure your diagnosis of lipedema is properly documented and supported by the medical record
- Choose a surgeon and get a letter of medical necessity with a surgery plan, if you have not already done so
- Schedule examinations to supplement your diagnosis.
- Get letters from your doctors supporting your diagnosis and surgery
- Have your functional deficits professionally evaluated
- Document your conservative measures
- Edit templates for letters that we provide to you
- Submit documents that we provide to you, including previous coverage determinations
What We Give You:
- A proven step-by-step process that gets lipedema surgery covered fairly by your insurance
- Our professional review of your documents to help you avoid the most common errors
- Advice, based on our knowledge of the current state of lipedema insurance coverage, whenever you need it
- Proactive communication on your behalf, when needed, with physicians, insurance plans, state and federal agencies, and independent review organizations to resolve issues and get your surgery covered and scheduled as soon as possible.
How Much Does it Cost?
Before Coverlipedema.com, we routinely charged $4,000 to $6,000 to obtain full coverage for our clients. Now, through the power of our web-based processes, we can charge much less. Most of our members start with the Coverage Process™ Membership, which costs $500. If you need to appeal your initial determination, the Appeal Process™ Membership upgrade costs $875 for active members. If you need an out-of-network exception for your surgeon, the Network Process™ Membership is available for $250 or $750, depending on difficulty.
What Happens if I Don’t Get Covered?
We are confident that we can obtain coverage for most women, but we do not control surgeons, insurance companies, and review organizations, so we offer our members the Coverlipedema.com Guarantee. If you follow the Coverlipedema.com Processes and fail to get coverage, then fail to win your appeal, or fail to get an out-of-network exception and single case agreement, then we will give you free Coverage Process™, Appeal Process™ and Network Process™ Memberships (up to $2,375 value) as needed to enable you to try again. You can learn more about the Coverlipedema.com Guarantee by clicking this link.
I am so grateful for coverlipedema.com! Not only did they provide me with a step-by-step process to gathering the necessary documents to submit to my insurance company, but they were extremely helpful and responsive to my questions every step of the way.
Your Next Step
Please visit the information pages specific to your insurance plan for more information.
This page was updated on 3 September 2021