Your Insurance: Cigna
Cigna issued a coverage policy for lipedema surgery that is effective as of June of 2021.
Once an insurer has a coverage policy, you cannot expect to pay upfront and submit a claim later. You need to request pre-certification, and getting a “coverage” letter doesn’t guarantee you will be paid fairly. We do not recommend paying an out-of-network surgeon and submitting a claim later because insurers may only reimburse a few thousand dollars or less for your surgery. It’s far better to work with a surgeon who will lower their rates and enter into an agreement with an insurer in advance, so they are treated like an in-network surgeon.
The Cigna policy doesn’t address finding a qualified surgeon. If you plan on using an out-of-network surgeon, it will take our knowledge, experience, and connections to get covered. Depending on your state, insurance plan, and employer, your success rate can vary widely without our help. Sometimes a surgeon or patient gets lucky, but we can get patients approved for an out-of-network surgeon most of the time and, if not, assist with finding a qualified in-network surgeon.
The coverage policy prevents Cigna from arguing that liposuction for lipedema is experimental or unproven. However, we expect that instead of issuing blanket denials, their clinical team will scrutinize individual requests and deny them based on the diagnosis, conservative measures, and functional impairment. We have been helping women with UHC get covered for years and have the connections, data, and experience that quickly resolves these issues. We recommend that you work with us from the start to minimize the chances of having to appeal a denial which is more costly and time-consuming.
The Cigna policy covers skin excisions except for the abdomen. Most board-certified plastic surgeons prefer to treat the abdomen with a panniculectomy (tummy tuck) as it’s more effective. Coverlipedema.com has won coverage several times on appeal.
Cigna also doesn’t explicitly cover trunk liposuction (hips, abdomen, and buttocks), but other plans like Aetna also do not state that explicitly, but do cover. When you work with Coverlipedema.com we ensure that your coverage request includes data and evidence as to why covering the trunk is important for removing all of the lipedema and for improving pain and function.
Regarding out-of-network surgeons in states like California and Ohio, Cigna will likely refuse to pay for surgery with them because there are in-network surgeons. So, we do not recommend traveling to these states for surgery. In other states, we are usually able to help Coverlipedema.com members work with the surgeon of their choice. For the best chance of being covered for an out-of-network surgeon, we don’t recommend traveling too far from your home state. Plans have been clear that, if you will travel for an out-of-network surgeon, you can travel for an in-network surgeon. However, your type of plan and the state where you live are important factors.
Your Next Step
Learn about choosing your surgeon.