Choosing Your Surgeon
Who Will Be Your Surgeon?
Your choice of surgeon is the most important decision that will determine whether your insurance will cover your lipedema surgery. Currently, it’s still not easy to get lipedema surgery coverage, and you must choose a surgeon who believes in your right to get your surgery covered. In our opinion, only a few surgeons who are qualified to perform high-quality lipedema surgery are also able and willing to work with insurance companies to obtain your fair coverage.
How to make your choice
There are many surgeons to choose from for your lipedema surgery. Some have flashy websites, an extensive social media presence, and incredible before and after photos. Others, who you have never heard of, have modest websites and no social presence. Some operate in large hospitals and some are in private practice. Plus, there are so many recommendations on Facebook, but which ones can you trust? How do you choose your surgeon?
First, a Disclaimer
We can only help you make your choice solely based on insurance-related criteria. We make no judgments of the medical or surgical qualifications or outcomes of the surgeons we recommend. Our recommendations are based solely on our insurance coverage experience with them. As patient advocates for many years, we urge you to do your due diligence when choosing a surgeon based on your desired medical outcomes. We suggest that you speak with at least two surgeons before making your decision. Also, speak directly and privately with several of their former patients and ask them about their surgery outcomes, their insurance experience and the helpfulness and professionalism of the surgeon’s staff. While before and after photos are helpful, they can be manipulated, and some surgeons will only provide them when you have a consult and will not post photos of patients on social media. We know that choosing a surgeon is difficult and hope that the following information makes your choice easier.
Board-Certified Plastic Surgeons
For the best insurance experience, we recommend a board-certified plastic surgeon certified by the American Board of Plastic Surgery, which is the only board the American Board of Medical Specialties recognizes to certify doctors in the full range of plastic and reconstructive procedures. Your surgeon should specialize in lipedema liposuction surgery with over a third of their cases being lipedema and having treated at least 75 lipedema cases.
In terms of insurance coverage, a board-certified plastic surgeon is better because:
- An insurer will be skeptical of lipedema surgery performed formed by a physician who is not board-certified in plastic surgery.
- For out-of-network exceptions, an insurer could question how surgery with a physician who is not a board-certified plastic surgeon could be better and safer than using an in-network board-certified plastic surgeon.
- When the choice is between an in-network or an out-of-network board-certified plastic surgeon, it’s usually easier to argue that the out-of-network surgeon has more specialized skills and experience.
- A few insurers have been considering restricting lipedema surgery approval to only board-certified plastic surgeons.
Board-certified plastic surgeons are required to perform their surgery in an accredited, state-licensed, or Medicare-certified facility. We recommend only having surgery in a hospital or in one of these facilities, and never in an unlicensed facility or uncertified physician’s office. Some insurers also insist that surgery only be performed in an accredited, state-licensed, or Medicare-certified facility.
Finally, board-certified plastic surgeons adhere to a strict code of ethics and are required to complete continuing medical education, including patient safety, each year.
Most insurance plans are based on a network of participating healthcare providers. These providers are called in-network, participating, or contracted providers, and you are usually required to use them exclusively. However, only a limited number of in-network surgeons treat lipedema. These in-network surgeons tend to do fewer lipedema surgeries, have scheduling issues, and, even in large hospital systems, are not great with coverage requests and appeals. If you are interested in using an in-network surgeon, please feel free to make an appointment to talk to us, as there are a few who are willing to follow the correct process for getting insurance coverage.
Since lipedema surgery was not covered for many years, most experienced lipedema surgeons are currently out-of-network. That means your surgeon will not bill your insurance and only accepts payment in advance for surgery directly from patients. In turn, patients who submit their surgery claims, even if they are approved, might face much higher out-of-network coinsurance and deductibles and usually much lower claim payments. At Coverlipedema.com, we assist our members with getting out-of-network surgery covered as if it were in-network. We have been successful in 95% of our cases.
Single Case Agreements
Even with approval to pay in-network coinsurance and deductibles, the insurers could still only reimburse a few hundred dollars because the surgeon’s costs are “too high.” In this situation, your out-of-network surgeon will be able to bill you for the balance due. So, the safest way to ensure the insurer pays fairly and you don’t have surprise medical bills is a Single Case Agreement (SCA).
An SCA is a contract between your out-of-network surgeon and your insurance plan covering your surgeries as if your surgeon were in-network. It lays out all the costs for your surgery, so you know before the surgery what is covered and for how much. Usually, the insurer and surgeon can work out a mutually agreeable rate. Surgeon’s fees under SCAs have averaged $7,000 per procedure on the east coast, $9,000 in Chicago and Texas, and $11,000 -$13,000 in Los Angeles. Regardless, you are usually only responsible for your in-network deductibles, co-pays, and coinsurance, and those can all be reduced by your maximum out-of-pocket limit. That means that with intelligent scheduling, you may be able to complete all your surgeries in a calendar year for the lowest possible out-of-pocket cost. Usually, surgeons have to lower their fees to negotiate with insurers to make SCAs happen. Because of this, an SCA might not be possible for some more expensive surgeons, or you might have to pay extra for some of their services.
Some surgeons will tell you that they will enter into single case agreements, but, to our knowledge, have signed very few, if any, for lipedema surgery. While we expect surgeons to be ethical, we recommend that you ask to see their redacted SCAs from the past few months (HIPPA compliant, if personal health information is removed). You should also ask to speak with their patients who were covered by insurance. If they are not willing or able to show you these agreements or let you speak with their patients, you should reconsider your choice of surgeon.
Your Working Relationship with your Surgeon and Staff
Your relationship with your surgeon and their staff should be based on trust, respect, communication, and mutual understanding. They should provide you with proper documentation in a timely matter, never pressure you to schedule surgery and pay up-front before approval, and easily sign single case agreements with insurers. They shouldn’t force you to place large deposits to secure surgery dates before getting your insurance approval. They should never tell you that they “have to bill you more if you use insurance” or that “it’s not worth trying to get coverage.” Both of these statements are not true. They should never hold your surgical plan and notes hostage by refusing to give them to you so they can submit the request themselves, especially if they are out of network. Many highly qualified surgeons cooperate with insurance companies. There is no reason to use one who doesn’t have a good track record of working with insurance.
In light of all the above, to give you the best opportunity to have your surgery covered by insurance, we recommend the following surgeons who are board-certified plastic surgeons with significant lipedema surgery experience and who have signed numerous single case agreements with multiple insurance companies:
Dr. Karol Gutowski Chicago, Illinois drgutowski.com
Dr. Daniel Krochmal Chicago, Illinois krochmalplasticsurgery.com
These recommendations are based solely on our working relationship and experience with these surgeons with insurance coverage. They have been easy to work with for insurance coverage. We receive no compensation, financial or otherwise, for our recommendations.
Join Coverlipedema.com Now
If one of the recommended surgeons is performing your surgeries and you are not covered by Kaiser, Medicare, Medicare Advantage, Medicaid, or Federal Employee Plans , you can sign up directly without speaking to us by clicking the “Join Now” button below.
Make an Appointment for a Phone Consultation
If you are working with the following surgeons, please make an appointment to speak with us. While we also recommend them, we need to confirm several issues regarding insurance coverage before you can join. Please make an appointment to talk to us by clicking the “Make an Appointment” button below.
Dr. Boris Volshteyn West Long Branch, New Jersey sierraplasticsurgery.net
Dr. Omar E. Beidas Orlando, Florida Omar E. Beidas, MD (orlandohealth.com)
Dr. Allison C. Nauta Portland, OR https://www.ohsu.edu/providers/allison-c-nauta-md
If you want to use another surgeon, or are unsure about your choice of surgeon, or are covered by Kaiser, Medicare, Medicare Advantage, Medicaid, or Federal Employee Plans, or have other questions that are not answered by our website, please make an appointment to talk to us by clicking the “Make an Appointment” button below.
I cannot say enough good things about my experience with Cover Lipedema. They are an ally and partner in care that has knowledge, experience, contacts and resources that a patient could never have.
If you are ready to join Coverlipedema.com, are working with a recommended surgeon and are not covered by Medicare, Medicare Advantage, Medicaid, or FEHB, please click the button below to become a member.
Make an Appointment
If you are not working with a recommended surgeon, are covered by Medicare, Medicare Advantage, Medicaid or FEHB, need to confirm issues or simply have questions, please click the button below to schedule an appointment to speak with us.
This page was updated on 12 March 2021