Facing a BMI Limit on Surgery Coverage? These 4 Strategies Can Help You Fight Back
With resources, links to supporting clinical evidence, and templates you can use for appeals
There is a growing trend in medical insurance policies for liposuction to include strict BMI limitations. Over the past month, I’ve been told about policy updates on various insurances, which are about restricting BMIs for the person requesting liposuction surgery.
The BMI limits on policies are typically between 31 and 35. As we know, women with lipedema typically have an average BMI of 40, with a range usually between 35 and 50.
Our BMIs are unusually high because our lipedema fat cannot be exercised or dieted away, and there is only so much we can do to decrease lymphatic fluid. Manual Lymphatic Drainage (MLD), compression garments, and other conservative treatments help temporarily manage swelling, but they don’t address the underlying fat deposits.
Using BMI as a strict cutoff fails to reflect the true medical needs of lipedema patients and contradicts emerging clinical evidence supporting liposuction as an effective treatment—regardless of BMI.
Why are Insurance Companies Restricting BMI’s for Liposuction?
There are not many reasons I can outwardly find on the “why,” but I can take a good guess. Here’s what I’ve concluded:
Risk of Complications:
Higher BMI = Higher Surgical Risk. It is a concern in the medical/surgical field that a larger person is at higher risk for surgical complications (including complications like poor wound healing, infections, and anesthesia issues) than those with less body mass.
However, Liposuction for Lipedema Has a Low Complication Rate!
Studies have demonstrated that liposuction procedures for lipedema patients, including those with higher BMIs, have low complication rates, challenging the notion that higher BMI inherently increases surgical risk.
In a study involving patients with BMIs up to 50.6 kg/m², the complication rate was only 1.39%, with no major complications reported.
Cost Control:
This is likely the real reason for restricted BMI’s: Insurance companies use BMI as a gatekeeping metric to reduce the number of prior authorizations they have to approve.
This new issue with limited BMI will likely gain more traction with more insurers. I encourage everyone to submit their prior authorizations anyway, regardless of this problem. Also anticipate that you will get denied and need to go to appeals and plead your case.
Here’s how to address BMI restrictions: