Insurance coverage for lipedema surgery has become more attainable recently. Previously, insurance was usually denied because it was considered a cosmetic procedure.

Now many insurance companies have changed their coverage policies and consider it medically necessary when all criteria are met:

• Conditions or symptoms are present in all of the following:
  • Pain in affected areas
  • Bruise easily
  • Weight loss efforts do not show any improvement in affected areas
  • Swelling in limbs
• Medical examination to confirm evidence of the disease. Photographs must be submitted along with the findings. All the following must be submitted:
  • Bilateral symmetric adiposity (fat accumulation) in the affected extremities
  • Tenderness and nodularity of fat deposits in lipedema affected areas such as dimpled or orange peel texture.
  • Non-pitting edema
  • Negative Stemmer sign. To do a Stemmer test, try to pinch and lift a skinfold at the base of the second toe or middle finger. If you can pinch and lift the skin, Stemmer’s test is negative.
• Physical function impairment involving the ability to walk or perform activities of daily living.
• Individual must respond to at least three consecutive months of medical management. You must document the conservative measures you took during this period, showing that you have not responded to the medical management.
• File for pre-authorization before you have surgery.

The First Step In Becoming Qualified for Lipedema Insurance Coverage

The first step is to have an in- person evaluation, so we can prepare your documentation for pre certification. While we are out of network with insurance, if your pre-certification is approved, we will seek a gap exception for you so that your coverage will be considered at an in- network rate. If your claim is denied, we will also assist you through the appeal process and participate in a peer- to- peer interview if required. Don’t let the insurance process discourage you. We are here every step of the way to do whatever we can to try to get your procedures covered.

Dr. Marcia Byrd recently was invited to host a question-answer session with women who were suffering or had friends who were suffering with Lipedema.

Insurance Coverage for Lipedema Surgery?

Insurance companies now are much better at approving some patients. Until recently, they did not approve at all, and considered it a cosmetic procedure. Dr. Byrd says, “There are two insurance companies that have been accepting coverage for Lipedema surgery and that is Blue Cross and Aetna. However, it is important to know, the patient must go through a protocol prior to surgery so they can meet the requirements of being approved.” The most important part is to get pre-qualification from the insurance prior to having surgery.

Does Lipedema Surgery Center Help With Surgery Verification?

The insurance companies now require that everyone first do a 12 week non-surgical therapy. Patients that want insurance coverage for lipedema to be approved must document very carefully that they have completed the steps. It is something new that Dr. Byrd now covers during consultations. If you had a consultation with Dr. Byrd and you’re not sure if you covered these steps, please call the office and the staff can go over the steps with you.

Non-Surgical Therapy Includes:

1. Healthy diet
2. Regular Physical Activity
3. Manual Lymphatic Drainage
4. Supplements
5. Compression Garments