Your Insurance: United Healthcare and Cigna
UHC and CIGNA are still in a lawsuit over lipedema coverage, and unlike Anthem and Aetna, who are also being sued, has not issued a coverage policy. So it is necessary to go to external review to win coverage. Most people win coverage on external review.
Winning coverage takes about four months and coverlipedema.com has a template appeal document for members that is easy to work with and continually updated with the latest coverage arguments. We also provide essential strategies and a database to ensure a fair external review and have even had final reviews reopened for poor quality.
Because UHC and CIGNA are not covering lipedema, there is more flexibility to submit claims after surgery if necessary but, ideally, we recommend you start the process for getting coverage at least 4 months before surgery. If you win coverage and have your surgeon enter into a single case agreement with CIGNA so you pay only in-network copays and deductibles. UHC and CIGNA will cover skin excisions along with liposuction in most cases unless your plan policy has limitations on reconstructive surgery.
UHC is the best payer for lipedema surgery and they have been reasonable about members seeing out-of-network physicians. At least 10 members have had their surgeries reimbursed in the past two years.
Many UHC and CIGNA members have self-funded plans. While members lose some state protections, coverlipedema.com provides strategies throughout the process to get more effective help from your employee benefits department.
UHC recently refused to enter into single case agreements for lipedema. They will pay out-of-network rates only. This arguably violates plan contracts and state laws that are supposed to provide for adequate care. This may change in the next few months, but it means that it will take longer to get paid fairly after you have surgery.
Your Next Step
Learn about choosing your surgeon.