Cohen et al (2021) stated that in adult men, buried penis occurs as an acquired condition most commonly caused by morbid obesity. Indian J Plast Surg. 2000;105(1):425-435. When Americans are working, they pay into Medicare through their years of employment. The mean amount of lipoaspirate in the LPARSP group was 1,054 613.5 ml. Both buried penis and LS can predispose to the development of penile squamous cell carcinoma (SCC); the diagnosis of this tumor can be delayed in men with AABP since an adequate penile examination is difficult or impossible. Abbed TM, Gonzalez-Heredia R, Sanchez-Johnsen L, et al. American Society for Dermatologic Surgery. Wound infection and genital lymphedema were reported in 4.7 % to 33 % and 7.1 % to 60 % of cases, respectively. Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Apfelberg DB. Copyright 2020-22 Coverlipedemaco, Inc. All Rights Reserved. Patient selection optimization following combined abdominal procedures: Analysis of 4925 patients undergoing panniculectomy/abdominoplasty with or without concurrent hernia repair. Until recently, insurance companies considered all liposuctionincluding surgical treatment of lipedemaan elective cosmetic procedure and didn't approve coverage. The most exciting thing this month was a California Medicaid plan that agreed to pay $7,000 per surgery - a great base for fair payment. Aesthetic Plast Surg. Assessment of risk of bias demonstrated a high-risk of bias across all studies. Medical history - allof the following (A, B, C, D and E): Physical examination - one or more of the following (A, B, C, or D): Extra criteria - either of the following (A or B): Source: Adapted from Halk & Demstra (2016). I managed the pain with occasional acetaminophen, though, and within a week the bruising was fading," says Lipedema Lady, who had similar recoveries after two lipedema surgeries. 2018;141(6):1395-1407. Ann Plast Surg. Learn more about our content standards. As with most insurers, having a cooperative employer or being in a regulated state can help us push Aetna to focus on quality of care regardless of whether the surgeon is in-network. Aetna has covered lymph sparing liposuction for patients with lipedema before and this policy update makes it more likely that they will cover it in the future but there always be restrictions. If the surgery is not deemed medically necessary, Medicare will not cover it. Available at:http://www.sages.org/primarycare/chapter35.html. Getting coverage for lipedema surgery is complicated. Throughout her life, Kristy has been told she was obese and needed to lose weight. Dermatol Surg. 2018;107(20):1081-1084. Liposuction for lipedema and lymphedema - Northwell In advanced cases of lipedema, lymphedema may occur. In rare cases, Medicare may cover a cosmetic surgery like liposuction if it's medically. Aboelatta YA, Abdelaal MM, Bersy NA. With insurance coverage, the cost can be as low as your maximum out of pocket cost, which could be less than $5,000. Dadras M, Mallinger PJ, Corterier CC, et al. Panniculectomy for the treatment of back pain; Abdominal lipectomy and/or correction of buried penis for the treatment of metabolic syndrome, or as an adjunctive procedure to assist with long-term weight loss following bariatric surgery; Adipose derived stem cell-assisted lipotransfer; Correction of buried penis for the treatment of erectile dysfunction. "The insurer may cover lipedema surgery in the some areas where lipedema tissue collects, but not all of the areas of body where lipedema tissue can occur," he says. 2012;45(1):77-88. Weve won over millions of dollars in coverage for patients insured by: And many other individual and employer plans! Even when multiple surgeries are required, lipedema surgery is usually considered to be well worth it. STEER: Succint and Timely Evaluated Evidence Reviews. Acquired buried penis in adults: A review of surgical management. Therefore, it is reasonable to perform allografts using the ADSC from younger individuals. "The fluid buildup can cause chronic pressure and pain, especially if it's near a nerve," says Dr. Schwartz. You must document the conservative measures you took during this period, showing that you have not responded to the medical management. Surgical versatility remains critical for successful outcomes. 1997;23(12):1151-1160. 2014;133(5):1214-1221. Coverage Rationale . Its easy to apply. This can be surgically removed via a, Though surgery often relieves the symptoms of lipedema, it's not a cure. It's common to need several rounds of liposuction for lipedema treatment; one RealSelf member, lippyleigh, needed seven. Aetna started covering lipedema in the Fall of 2019. Does insurance cover a mommy makeover? All of the following must be submitted: Bilateral symmetric adiposity (fat accumulation) in the affected extremities. The incidence of post-operative complications varied across studies (0 to 80.8 %), with greater than grade-4 complications reported in 3.1 % to 3.7 % of cases. These investigators also noted that the limited proliferation capacity of ADSC also prevented their widespread clinical use; ADSC lack telomerase and their telomeres are short; thus they can only proliferate in-vitro for a limited period of time. Individual must respond to at least three consecutive months of medical management. Toyserkani NM, Quaade ML, Sorensen JA. BJU Int. Lack of influence of weight loss on disproporonate fat distribution; Sensitivity to pain and easy bruising in fat distribution; Sensivity to touch and fatigue in extremies; No reduction of pain when raising extremies. For additional language assistance: Implantation of non-biologic or synthetic implant (eg, polypropylene) for fascial reinforcement of the abdominal wall (List separately in addition to code for primary procedure), Excision, excessive skin and subcutaneous tissue (including lipectomy); abdomen, infraumbilical panniculectomy [documentation required], Repair initial incisional or ventral hernia; reducible, Repair recurrent incisional or ventral hernia; reducible, Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair), Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible, less than 3 cm, incarcerated or strangulated, 3 cm to 10 cm, incarcerated or strangulated, greater than 10 cm, incarcerated or strangulated, Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible, Removal of total or near total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair, any approach (ie, open, laparoscopic, robotic) (List separately in addition to code for primary procedure), Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible, Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible, Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible, Implantation of absorbable mesh or other prosthesis for delayed closure of defect(s) (ie, external genitalia, perineum, abdominal wall) due to soft tissue infection or trauma, Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (e.g. J Dtsch Dermatol Ges. "Getting used to continually wearing compression garments would be in the best interest of your health," Dr. Schwartz says. Graf R, de Araujo LR, Rippel R, et al. The limit is generally around five liters, but sometimes that amount can go higher. No intra-operative complications were recorded. Lipedema is a fat disorder that typically affects only women. Cohen PR. "Awareness of lipedema is poor," says Dr. Wright. Unlike with standard liposuction (a cosmetic body-contouring procedure that removes relatively small areas of stubborn fat), the goal of therapeutic liposuction is to remove as much fat as possible. Other findings include edema, easy bruising, and increased tenderness. Aesthetic Plast Surg. The authors concluded that tumescent liposuction was a highly effective treatment for lipedema with good morphological and functional long-term results. Lipedema surgery is a specialized procedure that uses liposuction to remove the deposits of excess fat that accumulate under the skin as a result of lipedema. Heres what you can expect during recovery: RealSelf members tend to describe their recovery experience in similar ways. "Liposuction can give relief in size reduction, but it often doesnt make the lower extremities look much better," says Dr. Mats Hagstrom, a plastic surgeon in San Francisco. Most patients are pleased with the functional and aesthetic outcome following surgery. Based on available evidence and experience of the task force, answers were formed and recommendations were stated. The amount of money you will spend to have Coverlipedema.com advocate for you is the best money you will ever spend. Lipedema, aka painful fat syndrome, is a progressive condition: if it's not diagnosed at an early stage, people often become increasingly heavy in the lower body and their level of pain, tenderness, and swelling increases. Most patients can return to work in two weeks and fully get back to normal activities, including workouts, in up to six weeks. Liposuction for Lipedema is considered reconstructive and medically necessary to treat . Outcome analysis of combined lipoabdominoplasty versus conventional abdominoplasty. You dont have to pay your surgeon upfront, hoping to get reimbursed or face surprise medical bills later. 2018;12(2):e1237-e1250. Aboelatta and colleagues (2014) stated that lipoabdominoplasty is nearly a daily aesthetic procedure. Koolen PG, Ibrahim AM, Kim K, et al. First Dutch guidelines on lipedema using the international classification of functioning, disability and health. State of Minnesota, Health Technology Advisory Committee. 2006;30(1):1-8. Lipedema also often has an unusual texture within the fat that can feel like rice, peas, or walnuts beneath the surface of the skin. The mean follow-up times for the 1st post-operative follow-up and the 2nd post-operative follow-up were 16 months and 37 months, respectively. Over the past three years, we have helped almost 400 women get over 40 million dollars of lipedema surgery fully covered. Aly AS, Cram AE, Chao M, et al. Patients that want insurance coverage for lipedema to be approved must document very carefully that they have completed the steps. Fair coverage is not only your right, but is a reality now. Second, a trusted source has informed us that Aetna has set up a group to focus on lipedema, which will mean much stricter reviews of preauthorization requests. Apronectomy in combination with major gynaecological procedures. Panniculushangs below level of pubis (below the distal end of the symphysis pubis), documented by high-quality color frontal-view and side-view photographs; The medical records document that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs over 3 months while receiving appropriate medical therapy (e.g., oral or topical prescription medication), or remains refractory to appropriate medical therapy over a period of 3 months; Documentation of high-quality color frontal-view and side-view photographs with pannus lifted to document presence of intertrigo. Atiyeh B, Costagliola M, Illouz YG, et al. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. Aetna Faces Modest Class Over Liposuction Coverage for Lipedema Abdominal skin sensation, objective functional and aesthetic measures of the abdomen, as well as patient-reported outcomes (Breast-Q), were analyzed. Sanchez LJ, Bencini L, Moretti R. Recurrences after laparoscopic ventral hernia repair: Results and critical review. 2012;46(3-4):139-144. Incisional hernia repair: Laparoscopic techniques. Nahas FX, Augusto SM, Ghelfond C. Should diastasis recti be corrected? 1998;101(6):1685-1691. File for pre-authorization before you have surgery. Suction-assisted lipectomy fails to improve cardiovascular metabolic markers of disease: A meta-analysis. The guidelines contain recommendations with respect to diagnosis and management of lipedema. 2016;40(2):309-318. Bridenstine JB. 2008;61(2):133-137. During your recovery (and ideally beyond), you'll be wearing compression garments, to help reduce swelling and encourage your skin to heal smoothly over your new contours. Patient management. Insurers continue to cover lipedema! I go into more detail in this article, but you might have to pay for your surgery out of pocket, since most insurance plans don't cover liposuction for lipedema. Aetna considers repair of a true incisional or ventral hernia medically necessary. To do a Stemmer test, try to pinch and lift a skinfold at the base of the second toe or middle finger. Heller JB, Teng E, Knoll BI, Persing J. First, tumescent local anesthesia will be injected into the fatty tissue to minimize pain and cause the blood vessels in the treatment area to shrink, reducing bleeding. 11050 Crabapple Road These investigators reported on a tailored combined approach to improve advanced lipedema in elderly women with multiple co-morbidities. Abdominoplasty and abdominal wall rehabilitation: A comprehensive approach. Last Review02/10/2023. PDF : 2023 TX Aetna CVS Silver: Houston HMO CSR 94 ON Standard Related: I Got Surgery for Lipedema, and Heres How Its Different Than Regular Liposuction. Patients showed significant reductions in spontaneous pain, sensitivity to pressure, feeling of tension, bruising, cosmetic impairment, and general impairment to QOL from the pre-operative period to the 1st post-operative follow-up, and these results remained consistent until the 2nd postoperative follow-up. Si vous souhaitez personnaliser vos choix, cliquez sur Grer les paramtres de confidentialit. The authors concluded that a tailored approach may be useful in advanced lipedema and was applicable even in elderly patients with multiple co-morbidities. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile. 2017;15(7):758-767. 02/10/2023 To adequately debulk, lipedema reduction surgery uses a small blunt cannula to remove larger volumes over larger areas in a procedure thats significantly longer than cosmetic liposuction, explains Dr. Wright. The U.S. is not yet using it, so the ICD-10 codes most used for lipedema are R60.0 and R60.9, which are generic codes for swelling. Minor adverse effects were temporary methemoglobinemia after tumescent anesthesia and post-surgical pain. And my legs feel lighter and oddly, my balance is better. These bulges are a hallmark characteristic of lipedema. 2021;13(2):e13067. This Coverage Policy addresses surgical treatments for lymphedema and lipedema. While these procedures are often associated with a high incidence of wound complications, these are often self-limited and patients experienced significant improvement in QOL measures post-operatively. Plastic Surgeon Dallas | Plastic Surgery Plano Richardson TX Ann Plast Surg. Wollina and associates (2014) noted that In advanced stages of lipedema, reduction of adipose tissue is the only available effective treatment. 1997;23(12):1127-1129. Evaluation and management of adult acquired buried penis. J Plast Surg Hand Surg. Aesthet Surg J. Friday: 8:30 am 5:30 pm Available at: http://www.emedicine.com/med/topic2703.htm. ASERNIP-S Report No. A total of 170 studies were identified and screened, and 21 studies (570 patients) were included. afficher des publicits et des contenus personnaliss en fonction de vos profils de centres dintrt; mesurer lefficacit des publicits et contenus personnaliss; et. Medicare does not cover liposuction surgery that people undergo for cosmetic reasons. Kotsougiani-Fischer D, Sieber L, Fischer S, et al. On behalf of the European Association of Urology (EAU) Guidelines Working on Male Sexual and Reproductive Health and EAU-Young Academic Urologists (EAU-YAU) Sexual and Reproductive Health Working Group, Falcone et al (2022) examined the literature to determine the benefits and harms of the surgical techniques used for the correction of AABP. Matarasso A, Matarasso SL. Links to various non-Aetna sites are provided for your convenience only. Doctors didn't believe her when she said she was constantly dieting . Photographs must be submitted along with the findings. A total of 28 patients were included; groups were similar in demographics. Aetna doesn't offer any individual health plan that covers bariatric surgery. Abdominoplasty with simultaneous laparoscopic umbilical hernia repair: A practical approach to preserve the umbilical vascularization. Patients who underwent minimally invasive SG at the University of Illinois Hospital and Health Sciences System from March 2008 to June 2015 were included in this study. Reichenberger MA, Stoff A, Richter DF. How long your recovery takes will depend on how many areas were treated and how much fat was removed. Many of the women were misdiagnosed as obese or having lymphedema. Belt lipectomy for circumferential truncal excess: The University of Iowa experience. Results of multicenter study of laser-assisted liposuction. They had the contacts and the knowledge to press for coverage for me. The first step to getting insurance to cover the surgeries. With the current situation of lipedema surgery coverage, we believe that the best opportunity for you to get your surgeries covered is to . Ottawa. Cassar K, Munro A. Surgical treatment of incisional hernia. The cost of cataract surgery not only depends on the equipment used and the IOL implanted, but on the skill of the surgeon, your overall health, and where you live in the country. This can cause fluid to accumulate, causing "real" edema in addition to lipedema, and potentially leading to blood infections and fibrosis, the thickening and scarring of connective tissue. This has been a TOUGH fight and BCBS of Texas finally agreed to cover but they still made it very hard. Furthermore, the LPARSP group presented with a decreased bulging rate (p = 0.05), and secondary refinement procedures were less frequently demanded (p = 0.02). Clin Plast Surg. Aesthet Surg J. (Either of these options will increase your cost.). Van Geffen HJ, Simmermacher RK. 1997;23(3):211-214. 2004;74(6):504-506. Light walking can help reduce pain, prevent blood clot formation, and boost blow flow, which can help with healing. Approach to the future operated patients. Patient-reported outcomes of robotic vs laparoscopic ventral hernia repair with intraperitoneal mesh: The PROVE-IT randomized clinical trial. Prior to surgery, your circulation should be assessed to ensure that your blood supply is healthy enough to allow appropriate healing, as well as to minimize any risk from the procedure from abnormal blood vessels that often are present in the affected areas. These investigators reviewed the current evaluation and surgical management of this rare and complex patient population. Reduction mammoplasty (also spelled as 'mammaplasty') for asymptomatic members is considered cosmetic. "Lipedema becomes a chronic inflammatory process that leads to pain and disability, particularly in the extremities," says Dr. Schwartz. 2018;42(6):1600-1608. Patients with central fullness and sufficient tissue surplus on the abdomen, thighs and flanks who received LPARSP and rectus plication were identified (LPARSP group) and matched for age and BMI with patients who underwent conventional abdominoplasty (CA group). Core GB, Mizgala CL, Bowen JC 3rd, Vasconez LO. "Medical insurersonly cover lipedema that issignificantlyimpairing mobility and ability to perform daily activities. The authors concluded that ABP is a complex urologic condition with equally complex surgical therapeutic options. patients who underwent SG alone (SG); demographics, co-morbidities, and % EWL were examined. You should never have to borrow money or crowdsource to pay for your surgery. North Adelaide, SA: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S); 2004. The evaluation of a man with AABP begins with a detailed history for condition-related symptoms. PDF Liposuction for Lipedema - UHCprovider.com Rhinoplasty - Rhinoplasty is a nose job. Cell-assisted lipotransfer: A critical appraisal of the evidence. After six months, most people see 75% of their final improvement. Lipedema . Thereare many stipulations around this coverage, Dr. Wright explains. How to get your health insurer to pay for your weight-loss surgery The induced differentiation of ADSC in-vitro may be replaced by supplying adipogenic stimuli to transplanted ADSC, in a process referred to as in-situ adipogenesis. Tumescent liposuction. Lipedema Surgery Pioneer Dr. David Amron to Become Best Practice Guidelines: The Management of Lipoedema. The authors concluded that lipoabdominoplasty with rectus plication represented a safe approach for donor-site closure in selected patients undergoing abdominal-based free flap breast reconstruction. Survey Outcomes of Lipedema Reduction Surgery, Liposuction Prevents Lipedema Progression, LIO Lipedema Updates for Lipedema Awareness, Misdiagnosis of Lipedema and Malnutrition, New Developments in Biomarkers of Lymphatic Malfunction, Manual Lymph Drainage and Complete Decongestive Therapy. The high incidence of graft-related complications should be taken into account when counselling patients and AABP care should be centralized to high-volume centers. 1997;23(12):1125. Nous, Yahoo, faisons partie de la famille de marques Yahoo. Does Lipedema Fat Come Back After Liposuction Reduction Surgery? Cochrane Database Syst Rev. Facility fee (e.g., ambulatory surgery center) 25% coinsurance Not covered None Physician/surgeon fees 25% coinsurance Not covered None 080700-090020-252257 Page 2 of 6. For larger volume fat removal procedures, some providers prefer a combination of either local and IV sedation or general anesthesia, so you'll be completely unaware of the surgery while it's being performed. 2004;8(3):208-212. Sex Med Rev. Liposuction, (i.e., water jet -assisted liposuction, micro-cannular) or lipectomy for the treatment of lipedema is considered medically necessary when ALL of the following criteria are met: pain in the affected areas easy bruising Does Lipedema Fat Come Back After Surgery ? ", Its important to realize that theres no cure for lipedema, so even after surgery, patients will need to work closely with their doctor to manage their condition. Dr. Wright recommends "a clean diet that contains lots of whole foods, like low-carb vegetables, healthy protein, and healthy fats, and limits or avoids all together highly refined carbohydrates like sugar, white bread, corn,rice, and potatoes.". Vastine VL, Morgan RF, Williams GS, et al. PDF BENEFIT PLAN What Your Plan Covers and How Prepared Exclusively for Other possible risks are similar to those with all types of liposuction: Your surgeon should explain all of those risks to you during your consultation, so you can make a fully informed decision. Lockwood T. Rectus muscle diastasis in males: Primary indication for endoscopically assisted abdominoplasty. A healthy diet thats low in refined carbohydrates is an important part of lipedema treatment., This type of diet reduces inflammation, which is thought to play a role in lipedema. 001). Depending on the type and severity of your lipedema, you may need two or more treatment sessions (as soon as a few days apart). Liposuction in the treatment of lipedema: A longitudinal study. We know how to overcome the roadblocks to getting your insurance company to pay fairly for your medically necessary treatment. Characteristically, there is a localized, symmetrical increase in subcutaneous adipose tissue in arms and legs that is in marked disproportion to the trunk. Cosmetic Surgery and Procedures - Medical Clinical Policy Bulletins - Aetna If you have any pre-existing conditions apart from lipedema, discuss them with your surgeon. Sunday:Closed, Copyright 2023 Marcia V. Byrd, MD | 11050 Crabapple Road, Building B, Roswell, Georgia 30075 | Telephone: 770.587.1711. Reich-Schupke and co-workers (2017) noted that the revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP). It's not a requirement, but compression helps prevent fluids from obstructing the susceptible lymphatic pathways. 2014;7:35-42. 2017;79(5):495-497. You can trust RealSelf content to be unbiased and medically accurate. Golladay ES. Tuesday: 8:30 am 5:30 pm Your health care providers will then be able to assist you in providing documentation of your treatment and, if conservative measures don't work, why lipedema surgery is medically necessary for you. Hematoma, a pooling of blood under the skin, Seroma, a pocket of fluid under the skin (a risk that can be reduced with a good compression garment), Thrombophlebitis, when blood clots form in the deep veins, Fat embolism, which occurs when a piece of fat separates and becomes trapped in a blood vessel, I Tried Renuva to Make My Hands Look More YouthfulHeres My Honest Review, 5 Famous Doctors on How Reality TV Affects Real Life, The Best New Clinically Proven Skin-Care Launches of 2023. These researchers described the clinical characteristics of 3 obese men with AABP and the associated features of the buried penis. Lipedema Surgery Pioneer Dr. David Amron to Become In-Network With An assessment of surgery for lipedema by the Canadian Agency for Drugs and Technologies in Health (CADTH, 2019) (Peprah and MacDougall, 2019) reached the following conclusions: "Evidence of limited quality from five uncontrolled before-and-after studies suggests that liposuction may be effective in reducing the size of the extremities and complaints associated with lipedema such as spontaneous pain, easy bruising, sensitivity to pressure, impairment in quality of life, restrictions to mobility, edema, feeling of tension and general impairment. Youll be encouraged to be up and walking around by the day after lipedema surgery. what causes ADSC to become liquefied in-vivo. Furthermore, the abdominal wall sensation of the flanks was improved in the LPARSP group (p = 0.05), whereby patient-reported outcome measures did not differ between groups. St. Paul, MN: HTAC; 2002. Immediate decisions without affecting your credit. In our experience, Aetna has been one of the best for lipedema surgery coverage. ALT's dedicated insurance team, with over 40 years of experience, worked tirelessly to secure coverage for lipedema patients, at no cost to . 2021;45(4):1431-1440. . If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. More than ever, most women will need the assistance of an advocate. Lipedema Surgery Pioneer Dr. David Amron to Become In-Network With LeBlanc KA. Currently, the best known treatment for lipedema is surgery of one form or another. An analysis of the different stages of the disease also indicated that better and more sustainable results could be achieved if patients were treated in earlier stages. This study investigated 36 consecutive female patients who underwent high-lateral-tension abdominoplasty combined with liposuction of the upper central abdomen and both flanks. It gives coverage to most of the people who are above the age of 65 and some younger people too. Insurance companies now are much better at approving some patients. Most insurance companies cover lipedema surgery.
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