There are over 300 research studies regarding lipedema. There are over forty, peer-reviewed journal articles reviewing the benefits, efficacy, and safety of tumescent, lymph-sparing liposuction as the only surgical treatment for lipedema. For a lay person the most daunting task is knowing which research is considered most scientifically sound and helps make your case for medical necessity. Lipoforlipedeareimbursement.com will be collecting, ranking and organizing research so you can use it. Below is valuable strategic information on how to approach denials based on inadequate research.<\/p>\n\n\n\n
Below is a list of the most common design\nflaws<\/em> used by insurance companies and independent review boards (IRB\u2019s) to\ndeny a procedure as experimental investigational, or unproven and not medically\nnecessary.<\/p>\n\n\n\n Don\u2019t be overwhelmed. My goal is to sort and\norganize the research so you don\u2019t have to wade through hundreds of pages of\nliterature. Our goal is to continually update the information as we learn of\nboth denials and approvals. The key to success is specific dates, specific\ninsurance companies and plans, specific outcomes (how many appeals), and what do\nwe think made the difference? Ranking information and providing it in a .txt or\n.xls format is essential to making it easier to appeal and win. Some information\nand research is useless and a lot of reimbursement advice on the Internet is\nsimply incorrect.<\/p>\n\n\n\n Each state may have specific rules concerning\nwhat is determined to be reconstructive versus cosmetic. For example, both\nbreast reconstruction surgery and cleft palate are protected by federal (breast\nreconstruction) and state (cleft palate repair) laws. Therefore, if you\u2019re in a\nstate that requires reimbursement for cleft palate as reconstructive, then it\u2019s\na state law<\/em> and no longer a carrier option. Note that you must mee their\nstrict documentation and risk guidelines. To my knowledge [MAR 2020] there are\nno state or federal guidelines concerning LS-TL for lipedema. This needs to\nchange.<\/p>\n\n\n\n As of the time of this writing the largest\ninsurance group reimbursing LS-TL for lipedema as medically necessary and\nreconstructive is Anthem-Blue Cross NC00009). This policy covers 14 states as\nwell as Amerigroup, an Anthem subsidiary providing Medicare Part-C and Medicaid\nservices in the following six states: Arizona, New Jersey, New Mexico, Tennessee,\nTexas, and Washington. We have numerous reports of other payments but a severe\nlack of detail concerning which carriers, dates, and circumstances.<\/p>\n\n\n\n Check back often as we will be updating all\nof the information on this website often [MAR 2020]. Currently the best list of\nresearch papers and books is on the Lipedema Foundation Website<\/p>\n\n\n\n https:\/\/www.lipedema.org\/books-and-papers<\/a><\/p>\n\n\n\n There is an Excel spreadsheet of over 300\npapers. Yes, that is an overwhelming number and I will soon be working to\ncreate a top ten list and sort and organize by type.<\/p>\n\n\n\n The latest publication at the time of this writing (MAR 2020), is very\nfavorable toward lymph-sparing, tumescent liposuction: Prevention of Progression of Lipedema With Liposuction Using Tumescent\nLocal Anesthesia<\/em>: Results of an International Consensus Conference.<\/p>\n\n\n\n https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31356433<\/a><\/p>\n\n\n\n I would look at it first. There are over 300 research studies regarding lipedema. There are over forty, peer-reviewed journal articles reviewing the benefits, efficacy, and safety of tumescent, lymph-sparing liposuction as the only surgical treatment for lipedema. For a lay person the most daunting task is knowing which research is considered most scientifically sound and… Continue reading
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