Thank you for choosing Total Lipedema Care to be a part of your Lipedema journey. We are offering a complimentary submission to your insurance provider, as we feel strongly lipedema reduction surgery should be covered by insurance. In order to do this, we need the following supporting information and documents:
You must have a PPO plan. Please call your provider’s member services department to confirm you have out-of-network coverage.
2. Personal Documentation
We will need written documentation of your lipedema journey. Please write (type) your story in detail starting with the onset of lipedema, how it’s affected your life, what doctors you have seen, and any conservative treatments you have tried.
3. Diagnosis from two MD’s
You will need two doctor’s letters confirming your diagnosis. Dr. Jaime Schwartz and Dr. Karen Herbst can both provide a diagnosis and will count as the two doctors. In order to receive a diagnosis from Dr. Jaime Schwartz or Dr. Karen Herbst, you must have a full evaluation, which is performed during a one on one consultation with each provider.
4. Conservative Treatment
We need a list of the conservative/non-surgical lipedema treatments you have tried and the time frame of the treatments. This list can include the use of compression garments, physical therapy, manual lymphatic drainage massages, exercise classes, any therapy you have tried, etc. In addition to this list, we will need supporting documentation or proof of treatment; receipts, notes from therapists, doctors, etc.
5. Treatment Receipts and Timeline
The history of your conservative treatment must be no less than three months; documentation is required for this bullet point. Examples may include; receipts, notes from therapists, memberships, notes from doctors, etc.
We will need photos of your lipedema-affected areas. Photos will be submitted to our office through our HIPAA compliant photo portal, and this step is done before the consultation, which allows the doctor to review your photos prior to a diagnosis. Photo instructions will be provided to you by our office staff. If you are seen in person, photos can be taken in our in-office photo studio.
7. Letter of Medical Necessity
Letter of Medical Necessity: We will provide this letter following a consultation with Dr. Jaime Schwartz and/or Dr. Karen Herbst.
8. Surgical Treatment Plan
You must have a long-term surgical treatment plan, which will be developed during the consultation. We will provide this documentation following the one-on-one consultation with Dr. Jaime Schwartz.
9. Consultation Notes
Consultation Notes: We will provide notes from your consultation with Dr. Jaime Schwartz and/or Dr. Karen Herbst. Any additional notes from other medical professionals that will help support your case are encouraged.
10. Functional Capacity Exam
Functional capacity examination: We will provide you with our exam location recommendations.
We are happy to review your insurance packet if you’re currently working with another group or organization.
From our experience, these are the minimum requirements for insurance submission. This list is subject to change, and please note that every patient, plan, and provider is different. Please understand the approval process comes from your insurance provider. Total Lipedema Care does not have control over your provider’s processes, however anything we can do to assist with the approval process we will.