Below are some common questions we get concerning reimbursement for medically necessary, reconstructive liposuction for lipedema. www.LipoForLipedemaReimbursement.com will help you get covered for out-of-network gap coverage. What does this mean? It means that all physicians must be contracted with an insurance company to be considered “in-network.” Most all doctors are… Continue reading
First download the One-Page Checklist and spend some time with it assessing where you are, what you have, and what you need to do. It is free. If terms are unfamiliar to you then download the Reimbursement Guidebook. There are dozens of additional documents, sample appeal documents and a library… Continue reading
After over 1,000 hours working on helping patients be reimbursed for medically-necessary, reconstructive liposuction for lipedema I am now working on how much the insurance pays in addition to approving the claim. This is important whether the carrier pays the surgeon or the patient. And yes, always refer to it… Continue reading
This is included more as a thought-experiment than a proven approval technique. 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 not tried this strategy yet. However, if you’re working on your second or third-level… Continue reading
The attached document is an Excel spreadsheet you can use and edit as you wish. It is a companion to the Checklist (one-page!) and the much longer (86 pages) Reimbursement Guidebook. Often you will notice that I have similar information formatted or organized differently. That is useful. Most people have… Continue reading
In 2020 there are numerous medical carrier reimbursement policies that fall into the “maybe” category. The policy references either liposuction or lipedema but states that it may be evaluated as reconstructive and medically necessary. In that case you have to work the four components of reconstructive: Improve functionality Restore to… Continue reading
These are additional filing tips in addition to the Reimbursement Checklist. 0.1 Intro In general I have short, one or two-page checklists and then much longer and detailed explainations of nearly everything. Work the checklists first and then look to the Guidebook or the Policy Evaluation Document for more… Continue reading
Below is a valuable list of Gotchas!, Catch-22, Carrier-Specific Rules, and confusing, ambiguous, and contradictory Carrier guidelines and policies. This is kind of advanced but worth your time–especially if denied. I would argue it’s best to review before you file your claim. 1 WHAT IS A GOTCHA! ? A Gotcha… Continue reading
Q: Isn’t Lipedema the same as Obesity? No, it is a condition in which there is a pathological deposition of fatty tissue, usually below the waist, leading to progressive leg enlargement. Lipedema is often misdiagnosed as simply obesity or lymphedema. There is no cure for lipedema and it does not… Continue reading
Always get the background of the Expert Opinion Physician. Typically it will be a Plastic Surgeon. If the doctor is not a recognized name in liposuction for lipedema or lipedema diagnosis, work to determine their level of expertise. Expert opinion is not qualified. Propose that the expert is not a… Continue reading
Single Case Agreement (SCA) with Insurance Companies Making the case for single case agreement (SCA) with insurance companies Most cosmetic surgeons have chosen not to be a part of any insurance panel. Patients pay directly for services (out-of-pocket). Your insurance company may direct you to the nearest plastic surgeon assuming… Continue reading
This is 25 pages, updated 9/15/2020 and a formal denial policy. There are references to 85 research papers in the reference list. You can read it before you submit your claim–so you know what you could expect–or wait until your first appeal.
The Excel Spreadsheet of this list is the end of this document. Below is a Visio Graphic of the same information. I recommend both and the graphic alone could take an hour to review and understand. This is a very important list. I recommend grading your documentation and case in… Continue reading
As a certified medical coder and record auditor I have reviewed over 10,000 medical records in my career. While not a doctor, I have researched hundreds of medical acronyms and medical diagnoses. My focus is slightly different from the physician. I am looking for statements that support the medical necessity… Continue reading
The attached spreadsheet is for the patient to maintain all the information they need to be reimbursed. It is imperative that the patient has everything in order before they contact the insurance company for the pre-authorization. The more documentation you have, and the better it supports the procedure as reconstructive… Continue reading