Can I use insurance for lipedema surgery?

Lipedema is a chronic disorder that affects millions of women worldwide and is characterized by an abnormal buildup of adipose tissue and nodules in the arms, hips, abdomen, and legs. Lipedema can affect a person’s quality of life, cause discomfort, and affect daily living. Board-certified plastic surgeon Dr. Solomon Azouz specializes in lipedema treatment and performs surgery with liposuction and skin excisions for his patients in Dallas. Dr. Azouz understands that lipedema is a chronic medical condition and therefore works with several insurance carriers to obtain coverage for lipedema.

What is lipedema?

Lipedema is frequently misdiagnosed or mistaken for lymphedema or obesity. There are some options that can help treat lipedema symptoms, including compression garments, a compression pump, or manual lymphatic drainage massages (MLD). However, even with these conservative measures, many women feel temporary relief and continue to experience pain, swelling, hypersensitivity, and easy bruising. Experienced plastic surgeons like Dr. Solomon Azouz use surgical techniques to remove unwanted fat deposits, which can relieve associated symptoms.

Understanding Insurance Coverage for Lipedema Surgery

Insurance policies differ greatly between providers and can make things complicated when it comes to lipedema surgery. Lipedema surgery has historically been excluded from regular health insurance coverage because many insurance companies classify it as cosmetic. However, lipedema is increasingly recognized as a medical condition that requires surgical treatment. Dr. Azouz has partnered with Cover Lipedema, an advocacy group that assists patients with insurance policy navigation, claim filing, and appeal denials. While the insurance application process can be lengthy, Dr. Azouz and his team collaborate closely with Cover Lipedema to advocate for their patients.

What is the insurance process for lipedema treatment?

While many plastic surgeons do not accept insurance for lipedema surgery, Dr. Solomon Azouz established the Lipedema Center of Excellence, Since establishing this program, Dr. Azouz has seen patients from across the United States, including Oklahoma, New Mexico, Louisiana, Arkansas, Kansas, Nebraska, and Vermont. Board-certified plastic surgeon Dr. Azouz has worked with various insurance providers, including Blue Cross Blue Shield, Aetna, United Healthcare, and Cigna.

1. Initial Consultation: Dr. Azouz reviews your medical history, evaluates the stage of lipedema, and creates a surgical plan that considers your goals as well as compliance with your insurance provider.
2. Medical Necessity: Lipedema surgery must frequently be certified as medically essential for insurance to pay for the procedure. Dr. Azouz can provide a letter of medical necessity, including a lipedema diagnosis and proof that conservative measures like compression therapy, diet, and exercise have failed.
3. Pre-Authorization: Dr. Azouz’s office can assist you in obtaining pre-authorization from your insurance provider to determine whether the procedure will be covered. This involves submitting substantial documentation, including detailed medical records from various providers, photos, a letter of medical necessity, and proof of conservative treatment.
4. Appeals Process: If an initial claim is denied, patients have the right to file an appeal. A successful appeal can be greatly increased by collaborating closely with an experienced plastic surgeon who knows the nuances of lipedema and insurance claims, such as Dr. Solomon Azouz.

Written by Henna Dahya and Rhiya Patel on behalf of Azouz Plastic and Cosmetic Surgery