Yes, this is the same Guidebook that is on Amazon.com. It is provided here at no cost to you and in .DOC format so you can copy-and-paste any of into your pre-authorization or appeal document. I am updating it every 4-6 weeks.
My goal is to update this document every 4-6 weeks. If the version is older than that you can e-mail me (see About Us page) or use the Contact Form.
Most of the Posts on the right are included in this document but not all. You can search both the website or the document for any topic.
Here is the Preface
My goal with this guidebook is to provide medical healthcare carrier reimbursement information for liposuction for Lipedema. The procedure has many names: Lymph-Sparing Liposuction, which includes both tumescent liposuction and Water-Assisted Liposuction.
The reason for all the different names is that technically, liposuction for lipedema does not resemble cosmetic liposuction other than the tools are the same. The focus and the technique is very different. And that distinction is at the very top of our “ToDo” list. If you can prove that the procedure is reconstructive and medically necessary (and safe) then most carriers will be reimburse you. Click here for the different names and liposuction types . This information is for patients, Providers, insurance carriers, researchers, professional associations, and legislators. If you’re a patient and new to the world of reimbursement, coding, and documentation–and find all of this overwhelming I recommend downloading our latest one-page reimbursement checklist available in the Downloads section of the website. If you follow it meticulously with your Providers it should increase your probability of being reimbursed significantly. Also review the 12-Step Reimbursement Plan in this Guidebook.
You could focus on those two summaries and win most of your cases.
For most of the additional sections in this Guidebook, unless you’re a Provider, professional association, billing specialist, or researcher, the key is just to know that the issue or term exists. Don’t feel you have to know everything about co-morbidities or the types and stages of lipedema. Just know that there are types, stages and co-morbidities and how that fact may impact your probability of being reimbursed.
After extensive research (May 2020) into liposuction for lipedema reimbursement, I found a lot of information is vague, out-of-date, or incorrect. There is a general lack of specificity and specific dates. As a medical reimbursement consultant, auditor, instructor, and certified medical coder I have spent thousands of hours and over twenty-years learning and perfecting my trade. It takes thousands of hours and years of experience to be good at carrier reimbursement for procedures commonly regarded as “not medically necessary.” Words matter; and specificity matters–they can make the difference between an approval and a denial. Concerning clinical expertise, I am not a doctor (but I do play one on TV*) so I always defer to experts on clinical issues. (Clinicians feel free to make suggestions and provide feedback).
Another glaring negative is the lack of editable / computer-readable documents. All of my information is available on the website: www.lipoforlipedemareimbursement.com and in MS-Word (.doc) and MS Excel (.xls) format. The goal is providing information that you can customize to your unique situation; cut-and-paste whatever you need into your appeal and overturn your denial.
Remember that many insurance adjusters will state that “liposuction is cosmetic.” Your mantra is:
“Liposuction for Lipedema, (aka Lymph-Sparing Liposuction, Tumescent Liposuction, or Water-Assisted Liposuction) is reconstructive and medically necessary; it is not experimental, investigational, or unproven. Research supports that it is both safe and effective.”
Repeat that to everyone you speak to, often until they’ve memorized it. You can shorten it to “reconstructive and medically necessary, but you get the idea.
*And I was the nerd in sixth grade, in the back of the class, showing everyone how to use the microscope