Updated Jan 22, 2021
While we don’t have more official payment policies for liposuction for lipedema we are getting more reports of payment. Aetna appears to be paying whereas Cigna (with an official denial policy) is difficult. Blue Shield of California may deny you several times and we have reports of very low reimbursement–so the current issue is not whether they pay but also how much they pay. The general feeling, in 2021, is that if you make the very best case that the surgery is medically-necessary and reconstructive–they will pay. All the tools you need are on this website. The Checklist, The Guidebook, the sample policy.
Anthem Blue Cross CA reimburses for liposuction for lipedema: NC00009; Cosmetic and Reconstructive Services Published 11/12/2019. This covers the following 14 states: CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, NY, OH, VA, and WI. Note that the adjudicators may be unfamiliar with liposuction for lipedema and deny the claim; be prepared to explain the situation and file an appeal. Your documentation must be well organized and perfect!
Numerous Providers have filed medical insurance claims for lymph-sparing, tumescent liposuction and been reimbursed including: Dr David Gruener, NY, Marcia V. Byrd, M.D., GA, Gayle Gordillo, MD, IN, and Dr. David Amron, CA.
In a 2017 review of reimbursement for 27 advanced, disabled lipedema patients who underwent lymph-saving tumescent, liposuction, 6 were approved and 4 were paid after multiple appeals ([about 30%] source: Aug 2 2017 Fatdisorders.org presentation on reimbursement).
There are currently (JAN 2021) “Bad Faith / breach of contract” suits in California against about a half-dozen insurance companies on behalf of patients with lipedema who were denied coverage for reconstructive, tumescent, lymph-sparing liposuction. It is expected that most will change their policies as a result and reimburse based on the reconstructive surgery conditions listed above.
Many insurance companies simply have not yet addressed treating lipedema with reconstructive, LS-TL. It is not specifically referenced in their Cosmetic and Reconstructive Surgery Policy. My goal, with your help, is to change this in 2021.