[Clinicians, please feel free to add or make recommendations to this document. You can reach me using the contact form – Jeff].
The main point here is that a carrier will deny your claim if the patient is too sick for the procedure and their concerns are not addressed. This type of denial is much different than its cosmetic, not medically necessary and not (3) investigational” or “experimental” or “unproven.” The carrier may reject it as “not medically necessary” due to the threat to the patient, not the efficacy or value of the procedure.
Dangers of non-treatment Due to the development of secondary lymphedema and the irreversible damage to the lymphatic system that occurs in later stages of lipedema, liposuction should be implemented as part of the standard therapy for lipedema at early stages. This will prevent disease progression, improve quality of life, and reduce the need for decongestive therapy.
Comorbidities and any threats to the patient must be addressed in the pre-authorization documentation; address how you will reduce any risk of injury (death) to the patient and that they are healthy enough for the procedure. Other pre-existing conditions may preclude the liposuction (see Kaiser Permanente 2014 California appeal denial).
Common comorbidities associated with a primary lipedema condition:
- Chronic Pain
- Diabetes mellitus and Metabolic syndrome
- Phlebitis (DVTs)
- Easy bruising often from no apparent cause or injury
- Arthritis of all kinds, especially Osteoarthritis in hips, knees, and hands, but RA common also
- MCAD
- Hypermobility
- Lymphedema (usually secondary) and angioedema (the latter comes with MCAD triggering usually)
- Celiac disease and all forms of gluten sensitivity (accompanying malabsorption and malnutrition and nutritional deficiencies despite diet and even supplementation sometimes.)
- Sleep apnea, both obstructive airway issues and Central Nervous System (CNS) Apnea (neurologic in origin requiring a sort of breathing “pace maker”)
- Sciatica
- Food and drug allergies and sensitivities with a lot of paradoxic and unexpected super sensitive reactions
- Chondromalacia (cartilage loss) of all kinds, especially patellae (loss of cartilage in the knees, but can occur elsewhere, e.g. hips)
- Chronically low Vitamin D levels
- Common Variable Immune Deficiency (CVID) of all kinds leaving us prone to frequent & worsening recurrent infections of all kinds, especially respiratory & UTI’s
- Dercum’s disease (looks like Lipedema plus MCAD). It causes fatty lipomas.
- Dysautonomia of all kinds, most notably poor temperature and BP regulation (high or low, see POTS below)
- Electrolyte imbalances (often low potassium)
- GERD (weak hiatal sphincters and MCAD can contribute here – the stomach produces acid in response to histamine from food reactions).
- Hiatal hernia (stomach to esophagus sphincter) and all other forms of hernias just about anywhere (inguinal, duodenal, abdominal, etc…)
- Irritable Bowel Syndrome (IBS) & proclivity toward constipation, but with quick flips to diarrhea (likely food allergies/MCAD).
- Kidney trouble (stones).
- Leaky gut syndrome.
- Low Magnesium levels.
- Low Selenium levels.
- Low Vitamin and Mineral Levels
- POTS (Postural Orthostatic Tachycardia Syndrome) – a subset of dysautonomia involving BP drops and syncope (fainting).
- Restless Leg Syndrome (RLS) and leg cramps (often eased by increased magnesium).
- Skin tears or rips, trouble suturing, would dehiscence (trouble healing post surgery, especially soft inner tissues).
- Tendonitis and bursitis of all kinds (aka “soft tissue rheumatism”, alt. tendinitis).
- Varicose and spider veins, often early onset, easy bruising and bleeding from same.
- Mood disorders, especially anxiety and depression.
- Auto-immune diseases
- Thyroid issues (high and low, often auto-immune despite normal TSH “levels”)
- Multiple Sclerosis