After accumulating hundreds of pages of information on how to be reimbursed for liposuction for lipedema, we now has the issue of “how insurance-friendly” is your chosen surgeon.” There is additional information on all of the specific terms in this article on this website. If you download the one-page checklist… Continue reading
This varies by insurance company. Each one is different but common periods are 90, 120, 180, and 365 days. If the insurance company does not receive your claim within their period it will be denied and you will be responsible for all charges. This has nothing to do with any… Continue reading
FOR IMMEDIATE RELEASE June is National Lipedema Awareness Month Memphis TN, June 12, 2020 Lipedema is often misdiagnosed as obesity, edema, or lymphedema. While all can be present with lipedema, it is a separate condition. When lymphedema occurs with lipedema it’s known as lipolymphedema, a secondary lymphedema. To accurately diagnose… Continue reading
The information below would be of most interest to those performing liposuction for lipedema, and in particular those who are interested in obtaining carrier reimbursement for the procedure. Please see my other posts concerning reconstructive versus cosmetic and medical necessity for coverage of those important reimbursement issues. The information below… Continue reading
After several months feedback has been to simplify, simply, and SIMPLIFY! I’ve updated the checklist (Aug 14, 2020). I now have a one-page concise version plus a longer, three-page version. The guidebook will be updated shortly in Aug 2020 and is now over 50 pages. While personally I think all… Continue reading
Recently Providers and researchers have asked me how they can help. Here is a list of questions. Don’t feel like you need to answer them all. Which ICD-10 code do they use for lipedema: R60.9, Edema, Q82.0 Familial Hereditary Edema, or E88.2: Adiposis dolorosa; Lipomatosis dolorosa (Dercum’s disease)? Do they… Continue reading
I encourage all doctors and associations to add, at the very least, the following single sentence to their website or blog (patients please share this with everyone who cares as well as your doctor; it can make the difference between reimbursement and a denial): There are two kinds of liposuction:… Continue reading
Lipedema: A Call to Action! (Buso G et al., 2019) Authors: Giacomo Buso, Michele Depairon, Didier Tomson, Wassim Raffoul, Roberto Vettor and Lucia Mazzolai, Wiley Online Library Obesity, 27, 10, (1567-1576), (2019). Below is an excerpt of the most salient parts in regard to reimbursement for liposuction for lipedema. For patients with minimal or no improvement following conservative… Continue reading
The following is in the conclusion of Dr Bertsch’s four-part series on Lipedema Myths. Bertsch T et al. Lipedema – Myths … Phlebologie 2019; 48: 47–56 47 Some of the criteria below have not been well-defined. There is no international standard or US standard for performing liposuction for lipedema. One… Continue reading
Lymph-Sparing Liposuction – Marketing Ploy or Medically Accurate Phrase? Our medical carrier reimbursement project for liposuction for lipedema is marketing something: that liposuction for lipedema is reconstructive and medically necessary. Toward that goal we want the very best verbiage that helps us win the most cases. I believe we need… Continue reading
Below is a list of terms, phrasing and supporting research you can include in your pre-authorization or appeal documentation package as appropriate: Medically effective FDA approved equipment Conclusions…the effect of the intervention on health outcomes Make argument …that measurement(s) or alteration affects health outcomes Safe or effective Exceeding the outcome… Continue reading
The most recent Excel version of the checklist is above. 1 Liposuction for Lipedema Reimbursement CHECKLIST. Asterisk * [right] means additional information is available on www.lipoforlipedemareimbursement.com [December 2, 2020] Check website for updates.2 Make a decision for surgery (in the future). [Website www.lipoforlipedemareimbursement.com]3 Review your insurance policy for coverage information…. Continue reading
Below I reviewed ten Experimental/Investigational (E/I/U) healthcare policies. The goal here is to compare and contrast them. While very similar, there are differences in the definitions, requirements, and restrictions. I have emphasized issues and terms I consider important. Remember my mottos: Words matter Specificity matters Dates matter Accuracy matters Tailoring… Continue reading
This term has different means depending on its usage. Many are inter-related. Clinical: It refers to whether treatment of a disease or condition is warranted medically. This is in regard to published Clinical Practice Guidelines (CPGs) for care for a particular condition. There are clinical guidelines for many conditions including… Continue reading
This is included more as a thought experiment. I don’t know if the “comparable procedure” argument would have any weight with an appeal review committee concerning reimbursement for liposuction for lipedema. I’ve never tried this strategy. However, if you’re working on your second or third-level appeal, it might be worth… Continue reading