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
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
Recommended updates to the lipedema.org coding page Aug 19 2020. https://www.lipedema.org/about-lipedema The information on the www.lipedema.org web page (Aug 19, 2020) is confusing and incorrect. Please see the update below. On June 12, 2020 an ICD-10-CM evaluation committee, headed by Dr. Karen Herbst with support from the American Vein and… Continue reading
Below is a sample letter to request a Reimbursement Policy Evaluation for Liposuction for Lipedema. While this example is Noridian Medicare, it can be used for any carrier. Just change the name and if they have any information in their manual I would add that as well. There are a… 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