Lipedema is a chronic and progressive condition that can cause a tremendous amount of pain to those who suffer from it. It’s characterized by the abnormal accumulation of fat in the lower body, most frequently in the hips, thighs, buttocks, and legs. In many cases, lipedema is debilitatingly painful and prevents sufferers from being able to walk or stand for long periods without feeling significant pain. Liposuction for lipedema can be effective in treating the symptoms of this condition by removing the excess fat deposits that cause pain and other symptoms. But how do you know if liposuction is covered by Medicare?
You may find it hard to access the right information on the internet, so we are here to help you in the following article, providing the best and updated information on best liposuction for lipedema, how much does lipedema liposuction cost, and how to get liposuction covered by insurance.
Is Liposuction For Lipedema Covered By Medicare
The liposuction procedure was developed as a purely cosmetic surgical procedure to improve the aesthetic appearance of targeted body areas and that is still the goal of most liposuction procedures performed today. Medical insurance providers consider all liposuction procedures to be cosmetic procedures with a few rare exceptions. Nearly all insurance plans have a policy exclusion language for liposuction procedures. It is possible to overturn the exclusion language in some instances; however, most of the time it is not.
Barriers to Medical Insurance Coverage for Lipedema
The United States medical system and insurance providers use the ICD-10 International Classification of Diseases to assign codes to medical conditions. The ICD-10 does not have a specific code for Lipedema. Currently, the most accurate codes are for Acquired Lymphedema and Hereditary Lymphedema, which are accurate, but not specific to Lipedema. There is a Lipedema diagnosis code available in the ICD-11 code set, but this coding system has not been adopted yet by the US. Since there is no specific ICD-10 code for lipedema disease, most medical insurers chose not to recognize Lipedema as a medical disease.
Medical insurance providers in the United States are critical of published research on lymph sparing liposuction for Lipedema. Although there are several surgeons in the US performing the procedure for Lipedema and showing significant improvement in Lipedema symptoms and improved quality of life, most of the larger studies published in peer-reviewed medical journals showing the safety and effectiveness of lymph sparing liposuction have been done in Europe. Most health insurers chose not to pay for lymph sparing liposuction for Lipedema because their medical reviewers are not convinced by the European medical literature on the safety and effectiveness of liposuction or lymph sparing liposuction. In this case, the insurance company may call the treatment “experimental”.
Insurance Approval Process
The first step is to be familiar with your insurance plan coverage. If your plan has language exclusion stating, “no liposuction for any reason”, it is a contract exclusion and can not be overturned on appeal. It is considered an “Administrative Denial”. The next step is to understand if you have “out-of-network” benefits. The majority of surgeons will be out of network for the lymph-sparing liposuction procedure. Since most plans require the subscriber to pay a higher percentage of the procedure cost for out-of-network benefits, it is important to understand what your benefits are and what your out-of-pocket expenses will be.
The insurance approval process begins with the initial submission for pre-determination / pre-certification. If you are denied, it is possible to appeal the decision (provided it is not an administrative denial). Generally, the submission, denial, and appeal process can take 4 – 12 months. The final level of appeal is to your State Board of Insurance and must be submitted to the state by the patient – not the physician’s office. The State Board of Insurance will submit your records to an independent reviewer for consideration. The independent review board will hold a hearing, and If the board overturns the denial from your health insurance provider, your insurance must provide coverage for your procedure(s).
It is necessary to provide evidence as to why the proposed surgery is medically necessary; not experimental, not cosmetic, and why the benefit should be approved, or the denial should be overturned. This is proved through photos, medical records, which you will need to obtain from all your doctors, physical therapists, MLD therapists, etc…, and letters of medical necessity. Medical documentation proving that you have Lipedema and that it is getting worse despite having tried months or years of less invasive non-surgical treatments is a requirement.
Our office will assist in obtaining pre-authorization or precertification for lymph sparing liposuction surgery. We will provide copies of your medical records, photos, a letter of medical necessity, and medical literature for your insurance provider and submit them on your behalf. Dr. Wright will also participate in peer-to-peer phone calls with the medical director from your insurance provider and will speak on your behalf at the state independent reviewer hearing. We have also found that writing a statement or letter explaining how Lipedema has affected your quality of life, your lifestyle, daily activities, ability to carry out daily tasks, ability to work and perform functions and responsibilities of your job, and the progression of the disease is also very helpful.
If your insurance is provided through an employer, it is also helpful to discuss the process with your Human Resource department. Some employers have the ability to approve medical procedures that are normally excluded or not covered by insurance on a case-by-case basis.
Even after working through the arduous task of insurance submission, denial, and appeal, we understand that most lipedema patients will not be able to secure insurance coverage and payment for the lymph-sparing liposuction procedure. For this reason, we offer a substantial discount to patients who wish to pursue surgery and must pay for it out of pocket.
How Much Does Lipedema Liposuction Cost
If you’ve been thinking about surgery as a solution to getting rid of your lipedema, then you’re at the right place. Dr. Thomas Su and his team of plastic surgeons are experts at treating Lipedema with liposuction and have helped over 500 women with this disease. Compared to other plastic surgeons or other doctors who do some liposuction, we at Artlipo have made liposuction our specialty and have created the most advanced methods to achieve the best results. In addition, we have been specializing in liposuction of the arms and legs for years and doing lipo 360 or circumferential lipo in these areas way before any other doctors thought this was possible. This has naturally led to our treating many thigh, lower leg, knee, calf, and ankle patients in the same manner, and thus becoming experts in liposuction of lipedema patients also. Unlike other practices, lipedema isn’t something we treat occasionally, it is something we treat literally every day and create some of the best results possible!
Effectiveness of Surgery vs Non Surgical Treatment
Although many women find some relief of their lipedema symptoms through non-surgical means, there is no doubt that surgery with liposuction provides significantly more benefits. This is because most of the non-surgical treatment available is palliative at best. Compression garments are not comfortable to wear all the time and give benefits only while wearing them. Also, the symptoms and progression of lipedema are not significantly altered by non-surgical means. Liposuction surgery which has been used to treat lipedema for over 20 years has been proven safe and effective in many different studies. When done properly with proven techniques, liposuction gives a comprehensive solution or cure to the many problems associated with this disease.
Benefits of Liposuction Surgery for Lipedema
- Symptoms– patients who experience tenderness or pain to light touch and pressure report that these symptoms go away very completely in most cases. Also, patients report that symptoms of heaviness and easy fatigue feel that after surgery a weight has been lifted off their legs. Overall, patients can return to normal activities that they couldn’t do before.
- Halt of Disease Progression– whereas lipedema is known to get worse over time and show rapid progression during certain periods, having liposuction to affected areas not only removes most of this fat, but most of the time slows or even halts return of the fat
- Prevention of Orthopedic issues– in cases of severe disease where upper thigh and knee fat is very large, patients may suffer from a widened gait which leads to joint damage and the need for early knee replacement. Removing this fat, not only gives pain relief, but corrects the gait and physical impairment. This can postpone or eliminate the need for orthopedic surgery.
- Cosmetic Improvement– liposuction can also bring about a profound change in the appearance of lipedema legs restoring what would be a normal look.
- Emotional Impact– many women with lipedema suffer emotionally with lack of confidence and depression resulting from the multiple facets of the disease. Liposuction in this case can make a profound difference in restoring a woman’s emotional health.
What Surgeons Perform Lipedema Liposuction
In the U.S. there are a wide scope of doctors who can perform liposuction to treat lipedema sufferers. Liposuction for lipedema is typically done awake with tumescent technique which is the safest and most effective method for lipedema. There are many different doctors that are doing this type of awake liposuction currently for cosmetic purposes that come from different backgrounds. These include doctors from dermatology, OB/Gyn, primary care, general surgery, etc. Surprisingly, plastic surgeons who do cosmetic liposuction are typically not trained in awake liposuction because they do all of their surgeries under general anesthesia. However, regardless of a doctors’ background or where they trained, no one is taught how to do liposuction for lipedema patients because it requires something very different and very advanced compared to the liposuction for typical cosmetic patients. Therefore, if a surgeon is to learn this it is usually after becoming very experienced in other areas and then figuring it out on their own.
Finding a doctor who knows how to do liposuction and also to treat lipedema is a challenge. Lipedema in most cases affects the thighs and lower legs including the ankles. Most doctors doing liposuction have never even treated the lower leg, calf, and ankles, and many believe it is an area that should not be done. Many doctors will tell patients that liposuction of the calves and ankles is dangerous or that there is not enough fat there to make a difference. Also, compared to typical cosmetic liposuction of upper thigh areas, lipedema liposuction is much more comprehensive. Most cosmetic patients have smaller inner and outer thigh bulges which are localized, however, the lipedema patient usually has large amounts of fat accumulation covering the entire upper leg, surrounding the knee, and encompassing the full lower leg. These patients often need liposuction involving the full leg in a 360 degree or circumferential manner, which requires different skills and is much more difficult. Few cosmetic doctors have treated thigh areas this extensively or do anything close to 360 lipo. Because of this, there are very few liposuction surgeons who have ever treated lipedema or are qualified to do it. That is why it is so hard to find a surgeon for lipedema much less one that can produce good results for you.
What Makes Us Experts at Lipedema Liposuction
Artlipo Plastic Surgery is a liposuction specialty clinic which has been performing awake tumescent liposuction for 15 years. During that time we have been devoted to doing the most advanced and complete liposuction going above and beyond what typical liposuction surgeons perform. We are masters of completeness, smoothness, and artistic blending. Lipo 360 or circumferential liposuction which is considered an advanced approach for most doctors is what we have been doing for most of the past 15 years. Treating full and large areas of the thighs is what we have always done for artistic reasons, even before we knew what lipedema was. Dr. Su has also been treating the lower leg, calf, and ankle areas since the beginning of his practice and created a specialty in this area for the past 6 years. As one of the few doctors in the country able and willing to treat calves and ankles with beauty and precision, his clientele for this particular body area has quickly grown. Patients from all over the U.S. and other countries now come to us on a regular basis for treatment of the knees and cankles. Another reason Dr. Su is so good at treating lipedema is because of our Celebrity Arms liposuction. This is a 360 degree high definition lipo of the upper arms which is performed on all women, but applies particularly well to lipedema patients since 30% are affected in this area. Our 360 degree arm lipo approach is something that was literally pioneered by Dr. Su over 8 years ago when no one else was doing it, and has not been emulated until recently by only a tiny number of other doctors. After almost 2000 of these circumferential arm cases, we have gained more knowledge of sculpting arms and limbs than any other clinic worldwide. The experience and skills we have developed in treating the arms has been directly applicable to what we now do in the legs and thighs for lipedema.
While initially, Dr. Su’s specialization of the the cankles and knees were for cosmetic reasons only, Dr. Su later learned about lipedema and realized in hindsight that many of his prior patients actually had this disease. His subsequent journey over the last 3 years has been about learning more about lipedema and gaining experience and knowledge from the 500 or more patients he has treated. Dr. Su has also taken the effort to train with Dr. Joseph Stutz in Germany, one of the world’s authorities on lipedema surgery. Germany is where most of the research on lipedema has been done, and where this disease was first brought to the forefront of medicine. After training with Dr. Stutz, Dr. Su has gained a significant amount of insight into treating lipedema patients versus typical cosmetic patients, particularly in regards to doing it safely and sparing the lymphatic system.
What is “Lymphatic Sparing” Liposuction and what type of liposuction do I need?
When it comes to removing fat in the lower legs and ankles with liposuction, there has in the past been concerns about potential damage to the lymphatic system. Damage to these structures would not be good because it could lead to fluid build up in the areas otherwise known as edema. What the doctors in Germany figured out years ago when treating patients with lipedema is that using the technique of tumescent awake liposuction was safer for preservation of the lymphatic system. Specifically, the micro-cannulas (lipo instruments) associated with tumescent liposuction made a difference compared to the much larger cannulas used in liposuction by surgeons when their patients are under general anesthesia. However, in addition to using tumescent anesthesia and micro-cannulas to help preserve the lymphatics, the doctors in Germany developed what they call a “lymphatic sparing” technique. The basis of this lymphatic sparing liposuction is to travel mainly in a longitudinal direction along the length of the leg rather than horizontally across. This ensures that the cannulas are traveling in the same direction as the lymphatic vessels and less likely to cause damage. Avoiding liposuction close to the muscle where the lymph vessels lie is also extremely important. Keeping all these things in mind it is possible to do liposuction of the entire legs without causing significant harm to the lymphatic system. This is how Dr. Su performs all his liposuction.
As far as what type of instrument or type of liposuction is used, there has been more disagreement. Many of the surgeons in Germany have used (WAL) water assisted liposuction also known as BodyJet, which is a specific form of tumescent lipo, but others use the traditional tumscent lipo with normal micro cannulas in what is known as (SAL) suction assisted liposuction. Both of these methods are very similar and each effective. The difference is that WAL adds a small jet of water to help break up and separate fat. Both of these methods are very well accepted by lipedema specialists around the world. There are other liposuction technologies that have aqlso been used with success which include (UAL) ultrasound assisted lipo, (PAL) power assisted lipo, and laser lipo. The benefits and or risks to the lymphatic system with these other technologies have not been as thoroughly studied, but every doctor has their own preferences and experiences. It important to remember, the skill and experience of the surgeon is what determines the outcome, not the tool that they choose. At ArtLipo, we use both SAL and WAL with our lymphatic sparing liposuction for lipedema.
What Lipedema areas can be Treated with Liposuction?
Liposuction can be performed anywhere on the body where there is lipedema. Most commonly this involves some part or all of the legs. Most women start with their lower legs and knees first, and later add the upper part of the legs and thighs. When we treat lipedema we are traveling around the entire circumference of the thighs, knees, or lower leg and ankles. The arms are also affected in about 30% of women with lipedema so this is an area that is treated. Unlike liposuction of the upper arms by other cosmetic surgeons who only treat the underarm, we are treating the entire upper arm and shoulders circumferentially. This is what is needed to remove all of the affected area. In many cases women with lipedema will also have a fair amount of fat on their forearms and this can be treated also. There is some disagreement whether lipedema affects the torso, but if there is a concern it can be treated as well.
Recovery for Lipedema Surgery
Recovery for liposuction usually refers to when a patient can get back to normal activities and work. Other times it refers to when swelling, bruising, and pain symptoms are gone and the tissues have returned to normal. In either case, the recovery for lipedema liposuction of the legs, knees, calves, and ankles takes the longest compared to all other body areas and often is much more intense. Patients can walk and resume normal sedentary activities almost immediately. However, they cannot restart exercise or strenuous activity on their legs for at least a month. As far as pain and swelling, these will vary a lot from one person to the next. Because this is a surgery that covers more area, the soreness will be greater in general. Dull pain and aches could persist for up to a couple of months or longer. Swelling in the feet and around the ankles is the most pronounced but can also extend up beyond the knees into the mid thighs. This body area swells the most and the longest in large part because of it is the lowest and most affected by gravity. Patients can expect severe swelling for 1-2 months, moderate swelling 2-4 months, and light swelling up to 6 months or longer. A small number of patients will even have light swelling 1 year out. Understanding that liposuction for lipedema takes more time to recover will prepare patients. Otherwise, some patients can get depressed with this longer recovery period.
Can Lipedema return after Surgery?
Overall, liposuction which removes fat very completely (80-90%) will have very lasting results. Meaning that if a patient stays relatively within the same weight range, the fat will not return. Typically, fat will not return to an area of liposuction unless there is a large weight gain of 30lbs or more, in which case most of the fat still goes elsewhere. In lipedema patients, it is also expected that we see very lasting results and a halt of the progression of disease in most cases. However, in medicine and in dealing with the human body, all things are possible and no guarantees can be made about lipedema fat.
Lipedema Liposuction Cost
Costs of liposuction for lipedema are going to vary from doctor to doctor and depend on a number of factors. Of course, the larger the area, the more it will cost. Even if doing the exact same areas, one doctor can charge much higher than another. This could be due to the fact that one doctor is very good, and in high demand while another is not. Liposuction results all depend on human skill, not on technology and results can vary tremendously. Another factor which determines the cost is how much fat there is to remove and how difficult the case will be. Having a very large thickness of fat will take longer, and loose skin which is more difficult to work with will also drive up the cost.
At ArtLipo, you can expect some of the very best results from lipedema liposuction because of the experience and skill of our surgeons. This means more complete results with a more noticeable change in size, smoothness, and also a more beautiful shape compared to what other surgeons are typically able to produce. Our costs can be higher than some, but definitely worth the results. For a full leg liposuction including the thighs, knees, calves, and ankles done in a 360 degree manner, the costs can be $20,000 or more depending on size of the patient. Doing all of these areas will require 2 sessions split up between upper and lower areas. Not all patients will need a full leg liposuction. Many will achieve a significant improvement with just the knee complex, calves, and ankles which costs on average $12,000 and also varies according to size. The other area which our lipedema patients often treat is their circumferential arms which on average costs $9000. All treatments can be tailored to each individual. Therefore, it is best for you to send us your pictures and for us to give you an exact quote.