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New Lawsuit Against Denying Coverage for Lipedema Treatment

If you do a simple online search you can find plenty of cases where lipedema treatment has been denied to potential patients. Lipedema can be extremely difficult to diagnose when you do not have a trusted physician to assist you. Recently, a new lawsuit was filed in Los Angeles County on May 16th by law firm Gianelli & Morris. The lawsuit was filed against Kaiser Foundation Health due to an alleged breach of contract by refusing to cover a surgical treatment for lipedema.

Allegations Filed

The plaintiff was denied the requested coverage for lipedema treatment by Kaiser Foundation Health. The treatment in question was a liposuction procedure to reduce the impact of lipedema. Kaiser countered the allegation, stating that they did not have access to physicians with the proper experience for the procedure. Instead of allowing the treatment to provide relief to the patient, they denied any form of compensation.

Treatment in Question

One important aspect of the lawsuit is that Kaiser Foundation Health implied that liposuction for lipedema is an experimental surgery. Studies have continued to show that lipedema liposuction is both safe and effective and can provide relief for the many symptoms of lipedema. The lawsuit specifically points out the benefits identified through various studies at the Stanford University Medical Center.

Gianelli & Morris

The plaintiff in the case is being represented by Gianelli & Morris, a successful law firm that has represented several state and federal cases for lipedema treatment denial. Robert Gianelli continues to remain committed to helping lipedema victims receive the treatment they deserve and need. Kaiser had referred their patient to a doctor who unfortunately misdiagnosed them with obesity; the doctor went as far to state they do not see lipedema as an actual condition to be diagnosed. Lipedema treatments deserve to be seen as what they are: a medical treatment that is not experimental or just for cosmetic purposes.

What to do you think you might have lipedema?

Unfortunately, there are not that many physicians who recognize the disease, and also can rule out confounding diagnoses, such lymphedema secondary to venous insufficiency with a Doppler venous ultrasound.  Only with the proper clinical exam of the patient can a doctor rule out secondary lymphedema and other foot disorders to make a reliable diagnosis of lipedema.  You should be suspicious of doctors who claim they can diagnose lipedema over Skype.  The diagnosis is an important first step in getting the proper treatment and it also helps to build a case if you decide to try to get insurance coverage for your lipedema treatment. Do not let the reports of denied coverage prevent you from seeking the help you need.

Treatment of Lipedema

The surgery can be expensive and unfortunately as the Kaiser case above illustrates in some cases, patients may have to use legal remedies to get their medical insurance company to cover the needed care. It can be difficult but some insurance companies are starting to cover some treatments for lipedema .

All the published guidelines recommend treatment should start with compression garments and lymphedema therapy. If the non-surgical treatments like such as compression and lymphedema therapy do not give adequate relief patient medical insurance in some cases will cover specialized lymph sparing liposuction as an out of network benefit.  If you chose to proceed with lymph sparing liposuction, please chose an experienced surgeon who fully understands the disease, takes great care not injure the lymphatics and will work with your lymphedema therapist and other members of your care team.