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
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
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
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