Terms of Service
The healthcare system can present people with problems that may be unsolvable even with the best advocacy. Coverlipedema.com cannot guarantee coverage and payment, but we are certain that women will do considerably better using Coverlipedema.com than if they were to rely solely on social media or their surgeon’s office staff. Our mission is to make lipedema surgery coverage easy for anyone who needs it. To accomplish this, we ask that you abide by the following Terms of Service.
Access to the Pages and Content of the Website
You have access to the Membership pages and the Content of Coverlipedema.com as described by your Memberships, including Plan Strategy, Coverage Process™, Appeal Process™, Appeal Process™ Upgrade, and Payment Process™, for the amount of time described when you purchased or were granted your Membership. If your needs extend beyond that time, we are willing to extend your access reasonably. The Membership content of this site is meant to be used only by Members for their own purposes to obtain insurance coverage and payment of their lipedema surgeries during the term of their Membership. Membership does not grant the right to resell, copy, repackage, or publicly display our materials. Membership does not give you the right to share content from your Membership with other Members or non-Members who do not have access to the content of your Membership. Please do not share your login credentials with anyone else. We do not allow advocate access for third parties. These restrictions on the content of the website extend beyond the expiration, cancellation, or termination of Membership.
No Guarantees or Warranties about Results
Coverlipedema.com makes no guarantees or warranties about the results of a Member’s coverage requests, appeals, network requests, or claims. Coverlipedema.com is a user-driven, web-based tool that provides step-by-step processes that its Members have to complete themselves. As a Member, you are required to follow instructions, modify templates for letters and other documents, obtain various documents from your physicians, submit your requests to your insurance company, follow-up on those requests and respond to responses to those requests. Coverlipedema.com may recommend additional medical exams and evaluations that may incur additional costs not covered by Membership. While we provide assistance, direction, and advice, the burden of completion is on you, the Member. You are solely responsible for knowing and meeting deadlines for the submission of requests. You are ultimately responsible for the content and quality of the submissions that you send to your insurance company.
The Content of Coverlipedema.com
The content of Coverlipedema.com is unique and valuable. The materials herein are copyrighted and sharing them with others or allowing their use by other persons is strictly prohibited. Our template letters and appeal documents are copyrighted and for the use of the Member only. Third-party documents, such as coverage approvals, even when redacted, are not to be shared as a condition of your use in your coverage, appeal, and payment submissions. These restrictions extend beyond the expiration or termination of Membership. We offer discounted and even free services to people in demonstrated financial need. We stress that to prevail in coverage and payment issues, Members must have access to the latest information. We update and revise our documentation and templates frequently to reflect the almost daily changes in lipedema coverage currently. Not using the latest versions for coverage requests and appeals could lead to failure to obtain coverage or payment. We believe that every failed coverage or appeal submission will create the basis for future denials and undermine our mission. Our system is designed to keep costs low to encourage as many women as possible to pursue coverage through Coverlipedema.com. Sharing your log-in credentials, sharing the content of the website, or sharing our Templates with non-Members will be grounds for immediate termination of Membership without refund. Any further use of our materials will be prohibited, and such use will be punishable to the greatest extent of the law.
Social Media Policy
We are open-minded and encourage diversity of opinion. We cherish our Members and encourage them to reach out to us with any questions, comments, or complaints. We will always respond authentically. However, members who post audio, visual, or textual messages on any public media, including social media sites and apps, that portray Coverlipedema.com or its staff in an unfavorable or an inaccurate manner will be subject to the immediate termination of their Memberships, including permission for the continued use of our content, templates, documents and other benefits, without refund.
Requirement of a Collaborative Relationship
Coverlipedema.com requires a collaborative relationship with its Members in order to effectively and efficiently obtain fair coverage. We require good faith, adherence to our instructions and advice, trust, honesty, and sufficient effort. Should we believe that a Member or prospective member does not exhibit those requirements, we reserve the right to refuse membership or to terminate existing Memberships and the right to the continuing use of the website’s content and materials without notice. If Membership is terminated, all benefits of Membership, including but not limited to access to the site, informational materials, template documents, and coverage documentation are terminated. Refund of Memberships terminated prior to expiration will be subject to the discretion of Coverlipedema.com.
Requirement of Recommended Surgeons and Insurance Plans
The Coverlipedema.com Processes require the use of our recommended surgeons in order to to give you the best opportunity to have your surgery covered by insurance. These surgeons are board-certified plastic surgeons with significant lipedema surgery experience and have signed numerous single case agreements with multiple insurance companies. They understand how to participate in the Coverlipedema.com Processes. We currently recommend the following surgeons:
Dr. Daniel Krochmal Chicago, Illinois
Dr. Karol Gutowski Chicago, Illinois
Dr. Boris Volshteyn West Long Branch, New Jersey
Dr. Omar E. Beidas Orlando, Florida
Dr. Allison C. Nauta Portland, Oregon
Dr. David Kahn Palo Alto, California
Dr. Thomas Hagopian, Atlanta, Georgia
We are working with current Members who are patients of the following (We are not accepting new members):
Dr. Jaime Schwartz Los Angeles, California
Our Processes require surgeons who meet our criteria for the ability and willingness to help patients obtain insurance coverage of their surgeries. They must have relationships with their patients based on trust, respect, communication, and mutual understanding. They also should provide proper documentation in a timely matter, not push patients to pay up-front, and easily sign single case agreements with insurers. While we would like to support patients of all surgeons, our experience has proven repeatedly that using a non-recommended surgeon makes the coverage process much more difficult, if not impossible. We receive no compensation from these surgeons for our recommendations. If, at any time during your membership, you switch to a non-recommended surgeon, we reserve the right to immediately terminate your Membership without refund. If you switch to a non-recommended surgeon, you lose the right to use our website and documents and you may not share any of our proprietary documents based on our templates with your new surgeon. If a surgeon is removed from the list by us, we will continue to support our Members at our discretion. Members, however, must not share any of our proprietary documents based on our templates with the formerly recommended surgeon.
Additionally, Coverlipedema.com requires the use of insurance plans that are favorable for lipedema coverage. This requires us to speak with prospective members who are covered by Kaiser, Medicare, Medicare Advantage, Federal Employee plans, and Medicaid prior to allowing prospective members to join.
If a Member joins, but fails to meet the requirements for surgeon and insurance plan, Coverlipedema.com will cancel the membership immediately and refund the amount less the processing fees that we were charged by our payment processor and less a $50 refund processing fee. If a Member switches surgeon or insurance plan after joining or misrepresents their surgeon or insurance coverage, then Coverlipedema.com will immediately cancel membership and refund will be at the discretion of Coverlipedema.com.
Any personal data that you share with Coverlipedema.com will be kept confidential. We will not share our Member information with third parties without your consent.
Limits of Liability
To the maximum extent permitted by law, Coverlipedema.com shall not be liable for any indirect, incidental, special, consequential, indirect, punitive, incidental, or special damages, loss of profits, data or revenues, or other intangible losses resulting from the use of our website, its content or advice provided by our staff or from the termination of access to our website, its content or advice provided by our staff.
Any disputes which are not resolved by meeting and conferring will be submitted to final and binding arbitration under a mutually agreeable arbitrator. Costs of arbitration will be borne by the Member. The parties agree that there will be only one arbitrator. The arbitrator’s decision, including any decision about which party will pay costs and/or attorneys’ fees, will be final and binding.
Changes to these Terms
We may revise these Terms from time to time. The changes will not be retroactive, and the most current version of the Terms, which will always be at coverlipedema.com/terms-of-service, will govern our relationship with you. We will try to notify you of material revisions, for example via an email to the email associated with your account. By continuing to access Coverlipedema.com or use the Services and Content after those revisions become effective, you agree to be bound by the revised Terms. If you do not agree to any revision, please immediately cease accessing any Membership content and contact us to indicate your unwillingness to be bound by the revised terms.
If you have any questions about our Terms of Service, please contact us.
This page was updated on 21 July 2021