Your Insurance: Aetna
Aetna started covering lipedema in the Fall of 2019. About a dozen women have had their surgeries covered and Aetna reimbursed very well. Aetna also covers skin excisions along with liposuction per their policy. If you have not been reimbursed at least $8,000 per surgery, then you can and should request a review of your claim.
For comparison, Aetna paid Stanford $20,000 per surgery in-network. They are the most progressive plan in terms of covering lipedema and willing to work with out-of-network surgeons so members can have the surgeon bill them directly.
If you have been denied coverage in full or part, it is not necessary to appeal your claim. Coverlipedema.com can assist in determining if you are missing any documentation and provide you with the Aetna contacts necessary to resolve your issue.
If you are just starting the coverage process, it’s important to meet their detailed documentation requirements before submitting a request for coverage. As more members start requesting coverage, we expect they will deny more based on lack of proper documentation of the diagnosis or functional impairment. Coverlipedema.com guides you through that process.
Your Next Step
Learn about choosing your surgeon.