{"id":80,"date":"2020-02-29T20:51:14","date_gmt":"2020-02-29T20:51:14","guid":{"rendered":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/?p=80"},"modified":"2020-02-29T20:51:14","modified_gmt":"2020-02-29T20:51:14","slug":"lipedema-comorbidities-and-threats-to-the-patients-life","status":"publish","type":"post","link":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/lipedema-comorbidities-and-threats-to-the-patients-life\/","title":{"rendered":"Lipedema comorbidities and threats to the patient’s life"},"content":{"rendered":"\n

[Clinicians, please feel free to add or make recommendations to this document. You can reach me using the contact form – Jeff].<\/p>\n\n\n\n

The main point here is that a carrier will deny your claim if the patient is too sick for the procedure and their concerns are not addressed. This type of denial is much different than its cosmetic, not medically necessary and not (3) investigational\u201d or \u201cexperimental\u201d or \u201cunproven.\u201d The carrier may reject it as \u201cnot medically necessary\u201d due to the threat to the patient, not the efficacy or value of the procedure.<\/p>\n\n\n\n

Dangers of non-treatment<\/strong> Due to the development of secondary\nlymphedema and the irreversible damage to the lymphatic system that occurs in\nlater stages of lipedema, liposuction should be implemented as part of the\nstandard therapy for lipedema at early stages. This will prevent disease\nprogression, improve quality of life, and reduce the need for decongestive\ntherapy.<\/p>\n\n\n\n

Comorbidities<\/strong> and any threats to the patient must be addressed in the pre-authorization documentation; address how you will reduce any risk of injury (death) to the patient and that they are healthy enough for the procedure. Other pre-existing conditions may preclude the liposuction (see Kaiser Permanente 2014 California appeal denial).<\/p>\n\n\n\n

Common comorbidities<\/strong> associated with a primary lipedema\ncondition:<\/p>\n\n\n\n

  1. Chronic Pain<\/li>
  2. Diabetes mellitus and Metabolic syndrome <\/li>
  3. Phlebitis (DVTs)<\/li>
  4. Easy bruising often from no apparent cause or\ninjury<\/li>
  5. Arthritis of all kinds, especially\nOsteoarthritis in hips, knees, and hands, but RA common also<\/li>
  6. MCAD<\/li>
  7. Hypermobility<\/li>
  8. Lymphedema (usually secondary) and angioedema\n(the latter comes with MCAD triggering usually)<\/li>
  9. Celiac disease and all forms of gluten\nsensitivity (accompanying malabsorption and malnutrition and nutritional\ndeficiencies despite diet and even supplementation sometimes.)<\/li>
  10. Sleep apnea, both obstructive airway issues\nand Central Nervous System (CNS) Apnea (neurologic in origin requiring a sort\nof breathing \u201cpace maker\u201d)<\/li>
  11. Sciatica<\/li>
  12. Food and drug allergies and sensitivities\nwith a lot of paradoxic and unexpected super sensitive reactions<\/li>
  13. Chondromalacia (cartilage loss) of all kinds,\nespecially patellae (loss of cartilage in the knees, but can occur elsewhere,\ne.g. hips)<\/li>
  14. Chronically low Vitamin D levels<\/li>
  15. Common Variable Immune Deficiency (CVID) of\nall kinds leaving us prone to frequent & worsening recurrent infections of\nall kinds, especially respiratory & UTI\u2019s<\/li>
  16. Dercum\u2019s disease (looks like Lipedema plus\nMCAD). It causes fatty lipomas.<\/li>
  17. Dysautonomia of all kinds, most notably poor\ntemperature and BP regulation (high or low, see POTS below)<\/li>
  18. Electrolyte imbalances (often low potassium)<\/li>
  19. GERD (weak hiatal sphincters and MCAD can\ncontribute here \u2013 the stomach produces acid in response to histamine from food\nreactions).<\/li>
  20. Hiatal hernia (stomach to esophagus\nsphincter) and all other forms of hernias just about anywhere (inguinal,\nduodenal, abdominal, etc\u2026)<\/li>
  21. Irritable Bowel Syndrome (IBS) &\nproclivity toward constipation, but with quick flips to diarrhea (likely food\nallergies\/MCAD).<\/li>
  22. Kidney trouble (stones).<\/li>
  23. Leaky gut syndrome.<\/li>
  24. Low Magnesium levels.<\/li>
  25. Low Selenium levels.<\/li>
  26. Low Vitamin and Mineral Levels<\/li>
  27. POTS (Postural Orthostatic Tachycardia\nSyndrome) \u2013 a subset of dysautonomia involving BP drops and syncope (fainting).<\/li>
  28. Restless Leg Syndrome (RLS) and leg cramps\n(often eased by increased magnesium).<\/li>
  29. Skin tears or rips, trouble suturing, would\ndehiscence (trouble healing post surgery, especially soft inner tissues).<\/li>
  30. Tendonitis and bursitis of all kinds (aka\n\u201csoft tissue rheumatism\u201d, alt. tendinitis).<\/li>
  31. Varicose and spider veins, often early onset,\neasy bruising and bleeding from same.<\/li>
  32. Mood disorders, especially anxiety and\ndepression.<\/li>
  33. Auto-immune diseases<\/li>
  34. Thyroid issues (high and low, often\nauto-immune despite normal TSH \u201clevels\u201d)<\/li>
  35. Multiple Sclerosis<\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

    [Clinicians, please feel free to add or make recommendations to this document. You can reach me using the contact form – Jeff]. The main point here is that a carrier will deny your claim if the patient is too sick for the procedure and their concerns are not addressed. This… Continue reading → <\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[47],"tags":[35,38,11,12,44,45,13,5,6,20,46,21,24,16,23,17,34,18,22,26,27],"class_list":["post-80","post","type-post","status-publish","format-standard","hentry","category-clinical-issues","tag-appealing-a-denied-claim","tag-claim-denial","tag-comorbidities","tag-cosmetic-surgery","tag-diabetus","tag-dvt","tag-experimental-investigative-or-unproven","tag-lipedema","tag-liposuction","tag-lymph-sparing","tag-lymphedema","tag-medical-claim-form","tag-medical-insurance-companies","tag-medical-necessity","tag-medical-reimbursement","tag-plastic-surgeon","tag-pre-authorization","tag-quality-of-life","tag-reconstructive-surgery","tag-reimbursement-policy","tag-tumescent-liposuction"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/80","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/comments?post=80"}],"version-history":[{"count":1,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/80\/revisions"}],"predecessor-version":[{"id":81,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/posts\/80\/revisions\/81"}],"wp:attachment":[{"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/media?parent=80"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/categories?post=80"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/12uh.com\/lipoforlipedemareimbursement\/wp-json\/wp\/v2\/tags?post=80"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}