My First Denial and Appeal For Liposuction Surgery

I was pleasantly surprised by a partial approval for my surgery.

Hey L&M Community,

In my last article, I wrote about submitting my original request for liposuction reduction surgery. In this article, I listed all of the needed information to submit to my insurance. If you don’t know how to start your preauthorization process, I have an article listing the essential information you need for your surgical preauth, and how to get it here:

6 Critical Things You Need Before Submitting Your Preauthorization for Liposuction Surgery

It didn’t take my insurance long to send me a denial letter. Although I was expecting the denial, I was surprised that they actually approved my surgery!

They gave me approval for the surgery itself. I can’t tell you how happy I was that my surgery was approved. This approval told me they recognized my medical condition and agreed that surgical treatment was the correct path for me.

However, they denied my out-of-network surgeon, who’s a specialist in Lipedema.

My insurance has no out-of-network coverage. This means if they don’t already have a financial (in-network) agreement in place, They pay 0.00% of the charges.

It’s somewhat unusual for insurance to give no coverage for an out-of-network doctor. But I work for a medical care system, and as an employee, they only want me to use their hospital and contracted physicians. This hospital system also owns my insurance company (yes, huge medical care systems can own the insurance they give out as benefits to their employees).

Instead of my surgeon, they wanted me to use an in-network surgeon. They gave me a clinic I needed to go to instead for my surgery. This clinic is part of a large teaching university in my hometown of Portland, Or. My heart sank. I’m not too fond of the care at this hospital and try to avoid it. But, I needed to call and set up an appointment with them. If I didn’t, I’d never get approved for my surgery.

So, I called the clinic and asked for scheduling. I told them I needed a consult for lipedema surgery (The consult with my preferred surgeon wasn’t valid). She told me that the soonest I could get in for a consult was April 2023. That was a year away. On top of that, I’d have to wait for another year after that to schedule surgery.

I’d have to wait two years for surgery.

TWO YEARS!

This was an egregious amount of time to wait for surgery that I needed right now. I don’t know if it was even legal for my insurance to make me wait this long for surgery. But what I did know was I had the fuel for my appeal.

I had to show my insurance that waiting two years for surgery would have a detrimental effect on my health as my Lipedema continued to progress.

I wrote an appeal letter and included more documentation for my appeal. This focused on the detrimental effects delaying surgery would have on my body and how much more expensive it would be for them not to approve a surgeon who was able to perform my surgery now. My Lipedema had already significantly progressed in the entire year it took me to get to this point of requesting surgery. I’d gained over thirty pounds, and my Lipolymphedema was much worse, causing me to become chairbound.

With the help of my case manager, I submitted my appeal with confidence and hoped to get good news on the next go around.

Well, I didn’t. But I’ll tell you more about that the next time.

Here’s the good news, I did get approved! My insurance is covering both of my surgeries and with my requested surgeon.

My first surgery is on September 8th. I’ll continue to write about my journey, and I want to show others how to give yourself the best chance at getting surgery if that is your goal.

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Lipedema and Me is now on Tik Tok!

I love Tik Tok, and it’s a great way to bring snippets of information to the masses. Here’s my channel:

I want to get to 1K followers, then I’ll be able to do “Lives” and talk more freely about Lipedema and answer questions. So, if you are on this platform, please follow me!