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 coverage for lipedema treatment, 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 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 coverage. 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.
To be eligible for coverage of lipedema treatment 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.
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!
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:
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.
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.