We are pleased to announce that Dr. Wright accepts patients for Lipedema Reduction Surgery in-network with United Healthcare.  We are delighted that United Healthcare is working with us to provide the lipedema patient community with in-network lipedema treatment options.  Please be aware that United Healthcare’s medical necessity criteria must be met to their satisfaction before approval.  This includes six months of conservative therapy (diet, exercise, compression), photo documentation showing disproportionate tissue of the extremities, and documentation of functional impairment. We also highly recommend every patient document their personal journey to share with their provider and with UHC as a way to prove their need for treatment further.

We aim to help the lipedema community obtain affordable in-network treatment and care.  We will continue to work with other payers to achieve fair compensation for the expertise and outstanding patient care and outcomes we provide to our patients.

Lipedema is a chronic condition that affects many women, causing disproportional fat distribution and, often, significant physical discomfort. Fortunately, UnitedHealthcare (UHC) Insurance offers lipedema treatment insurance coverage, but it’s essential to understand their strict criteria and the steps required to get the coverage you need. We’re here to guide you through the process of obtaining insurance coverage for lipedema through UHC while also shedding light on the success Dr. Wright has had in securing coverage for his patients. 

United Healthcare’s Lipedema Coverage Policy

United Healthcare recognizes the challenges individuals face with lipedema and has developed a policy for treating this condition. However, it’s important to note that they have stringent criteria that must be met to qualify for lipedema covered by insurance. Below is the general outline of what criteria UHC is looking for. At the end of this article, we summarize the entire process that includes this criterion. 

Criteria for Lipedema Treatment Insurance Coverage

To be eligible for treatment for lipedema covered by insurance through UHC, you must meet the following criteria:

Diagnostic Criteria: You must meet all diagnostic criteria for lipedema. This includes having photographs showing disproportional fat distribution consistent with the diagnosis. Additionally, you must have documented evidence of the failure of disproportional fat to respond to medically supervised weight loss or bariatric surgery if your BMI is in class 2 or above (BMI +35).

Conservative Therapy: You should have attempted medically supervised conservative therapy for lipedema for at least six months. This therapy includes compression garments, manual lymphatic drainage (MLD), and a low-carb diet. Documenting your efforts and their lack of effectiveness is crucial.

Medical Evaluation: In addition to diagnosing lipedema, you’ll need another diagnosis from your primary care physician (PCP) or a specialist who is not providing surgery for lipedema. This diagnosis should support the need for surgical intervention to treat lipedema.

Functional Impairment: To further substantiate your coverage case, you must provide documentation of functional impairment. This could include how lipedema affects mobility, physical activity, and daily life. Be sure to detail the limitations you experience due to lipedema, as this will strengthen your case.

Dr. Wright’s Success with UHC Coverage

One positive aspect to highlight is that Dr. Wright has had significant success in helping his patients secure coverage for lipedema treatment through United Healthcare. This speaks to the importance of having a knowledgeable and experienced medical professional on your side when navigating the insurance process. His patients have seen great success with lipedema surgeries and long-term quality-of-life changes. Below he and one of his patients were even featured on FOX 2 St. Louis!

The Process of Obtaining Coverage

Now that you understand the criteria for UHC’s lipedema coverage policy let’s outline the steps to help you secure the coverage you need:

1. Consultation with a Specialist: Begin by seeking a specialist who can diagnose and document your lipedema. This specialist should not be the one providing surgical treatment. Make sure to discuss your functional impairment during this consultation.
2. Conservative Therapy: Undergo medically supervised conservative therapy for at least six months. Keep detailed records of your therapy sessions, progress, and any lack of improvement.
3. Medical Documentation: Request a separate diagnosis from your primary care physician or another specialist that supports the need for surgical intervention to treat lipedema. This diagnosis should complement the lipedema diagnosis.
4. Photographs: Obtain photographs showing the disproportional fat distribution consistent with lipedema.
5. Consultation with Dr. Wright: If possible, consider consulting with Dr. Wright or a similarly experienced specialist who can guide you through the insurance process. Their expertise can be invaluable.
6. Submission of Documents: Submit all the necessary documentation to UnitedHealthcare, ensuring that you meet all the criteria outlined in their policy.  Include your personal notes and information about your journey in this submission. 
7. Advocacy: Be prepared to advocate for yourself and your need for treatment. Insurance processes can be complex, but persistence can pay off.

United Healthcare does offer coverage for lipedema treatment, but they have strict criteria that must be met. By following the steps outlined in this article and enlisting the expertise of a knowledgeable specialist like Dr. Wright, you can increase your chances of obtaining the coverage you need to manage and treat your lipedema effectively. Remember that your health and well-being are worth the effort required to navigate the insurance process successfully.

Read more about the UHC Policy here.

We will make every effort to get patients approved for Lipedema Reduction Surgery; however, final approval for medical necessity and prior authorization is determined by United Healthcare and at the discretion of a Medical Director at United Healthcare.  We cannot guarantee patients will be approved for surgical procedures.

While getting coverage for lipedema surgery requires a good bit of work, this means more women can get treated and take the next steps towards a more mobile and full life. Please note that this information we provide to help you get insurance coverage is free and should always be free. We assist with insurance coverage for our patients at no charge and do not think it is ethical to charge for this assistance.

Find more information about lipedema surgery and insurance coverage here.