Lipedema is a fat disorder that causes enlarged legs and arms. It is often painful and disabling. Health insurance coverage varies for lipedema surgery.
How to Check If Your Health Insurance Covers Lipedema Surgery
The first step is to carefully review your health insurance policy or call your provider to learn about your coverage details for lipedema surgery.
Specifically, ask if lipedema procedures are covered or excluded. Some plans may cover lipedema surgery under reconstructive surgery benefits, while others classify it as cosmetic/elective and do not cover it.
Review Pre-Authorization Requirements
Your provider may require pre-authorization before approving lipedema surgery coverage. Be sure to follow any pre-auth requirements outlined in your policy.
Submitting the necessary medical documentation can help show that lipedema surgery is medically necessary in your case.
Comparing Insurance Plans – Which Offers Better Coverage?
Compare coverage policies when selecting a new plan or exploring alternative options. Look for plans that include lipedema surgery under covered reconstructive procedures, rather than excluding it as cosmetic. PPO plans tend to offer better coverage than HMOs. High deductible plans also have higher out-of-pocket costs for lipedema surgery.
Out-of-Pocket Costs to Expect if Lipedema Surgery Isn’t Covered
Lipedema surgery can be very expensive if you have to pay out-of-pocket. Costs vary but may range from $8,000 to $25,000 depending on the extent of treatment needed. Paying out-of-pocket requires significant financial planning and budgeting for most patients.
Consider All Financing and Payment Options
Explore payment plans or medical credit cards that allow you to pay lipedema surgery costs over time. Hospitals and private lenders also offer loans and financing options. Discuss costs upfront with your surgeon.
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Pro Tip: Appeal Insurance Denials For The Best Chance At Coverage
If your lipedema surgery claim is denied, be sure to go through the appeals process outlined in your policy. Provide documentation from your doctor explaining the medical necessity of surgery for treating lipedema.
Hire a medical billing advocate to assist with the appeals process if needed. Being persistent pays off, as many approvals are eventually granted after initially being denied.