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.
Below is a review of the current international guidelines for lipedema and their recommendations for liposuction. As of Sep 2020, we do not have a USA standard. I know several lipedema experts are working on one but it may be at least six months before we see one presented.The Buso… 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
What you must do: We are assuming that you’ve passed the approval hurdle, the surgery has been deemed to be reconstructive and medically necessary and not cosmetic. You have also discussed the number of procedures required (typically at least two, depending on severity). Often the insurance carrier will assign the… Continue reading
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… Continue reading
There is no national database that tracks all complications for all procedures so any number is an estimate. Deaths may be reported to state agencies but the number of cases done is not reported anywhere so while we may have an estimated numerator, there is no accurate denominator, especially since… 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
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