Lipedema Insurance Coverage
Lipedema Insurance Coverage in New York and New Jersey
Traditionally, cosmetic procedures are not covered by most insurance carriers.
In the past, the only plastic surgery procedures that were covered by insurance companies were panniculectomy after significant weight loss and breast reductions.
It took us about three years to establish relationship with local insurance carriers and educate them on Lipedema and Dercum Disease.
We have been successful in getting our patients approved by insurance carriers. We receive approvals from Blue Cross Blue Shield, Horizon, Aetna, CIGNA, Humana, UPMC, United Health care, Oxford, Empire, GHI and other health insurance carriers.
We commonly get approvals for Liposuction and Panniculectomy. Occasionally we are able to obtain approvals for removal of excess of skin from the arms or legs also.
However, the process is time-consuming and requires the patient to follow protocols, comply with requirements by their insurance companies, be patient and be actively involved in the process.
It usually requires additional specific testing, documentation from multiple providers qualified by the carriers and specialty peer review conference calls.
Each insurance company has its own policies, procedures and requirements. They may vary significantly one from another. Fortunately, we are well aware of most of them.
That being said, over 85% of our patients undergoing Lipedema procedures, have it covered through insurance.
At this point we are unable to provide any Lipedema procedures to patients with Medicare because Medicare does not recognize these procedures as medically necessary and has no preauthorization capability.
Obviously, to those patients who have no insurance or who are unsuccessful in getting their surgeries authorized or approved, we offer cash pricing. We also offer third-party financing.
Should you choose to have the surgery performed by Dr Volshteyn or his associates, we ask you to remember that your participation in the preauthorization process is critical. We will help and guide you through the process and we will assist you in getting preauthorization. However, the key to success is your active participation. Without it, the process is virtually impossible.