Your Insurance: Anthem Blue Cross Blue Shield
Anthem Blue Cross Blue Shield started covering lipedema in the Spring of 2020. That’s important since Anthem is the largest Blue Cross Blue Shield company with over 40 million members and often sets the standards for others.
However, 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 of functional impairment. The Coverlipedema.com Coverage Process™ guides you through the steps necessary to get approval.
Anthem will cover liposuction plus skin excisions and you likely will receive a coverage letter pretty quickly. However, Anthem’s intent seems to be to cover but not pay fair market rates for surgeries. People will get a coverage letter and think they are set. They will pay thousands of dollars out of pocket for their surgeries only to find out that Anthem will reimburse them less than 20 percent.
After getting covered, it is important to follow the steps of our Payment Process™ to make an out-of-network request to confirm you can use your surgeon and that you will be reimbursed at fair rates. Ideally, if you start the process early and your surgeon is willing, Anthem will make a single case agreement for your surgery. In St. Louis, we have recently been able to get Anthem to pay $6,500 for the surgeon’s fee. That rate would be higher in Chicago and Los Angeles.
If you submitted claims already to Anthem and were paid poorly, you can appeal those claims with our Appeal Process. We have a strategy for payment backed up with a database of materials that support fair claim payment that our members can access.
Your Next Step
Register for an Insurance Strategy Session and start working towards getting your surgeries covered!