The topic of financing lipedema therapy is a delicate business and unfortunately one of the main reasons for many lipedema sufferers to not have the operations done so far or to think about it for a long time, although our health is the greatest asset.
Unfortunately, the surgical lipedema therapy is not yet a fixed part of the health insurance catalog of benefits at the present time. This means that liposuctions for lipedema are not fundamentally covered by health insurance, although they are medically indicated operations, regardless of the stage of the disease.
Nevertheless, there are several ways of trying to have the costs covered by the health insurance or at least to have the surgery costs claimed as an extraordinary burden in the context of the tax return.
To make sure that you know everything about the chances of cost coverage in your stage of disease and in consideration of your own type of insurance, I would like to give you a short overview in the following:
If you have statutory health insurance, you are not entitled to have the surgical therapy covered by your health insurance in stages I and II. Unfortunately, liposuctions for lipedema are not yet included in the benefits catalog and are not considered medically necessary by the health insurance companies. Nevertheless, it is advisable to submit a cost estimate and an application with the request for cost coverage before the operations. A case worker will then look at your application, determine that liposuctions are not part of the scope of benefits and, in all likelihood, reject it. However, a written rejection from the health insurance company may also be useful to you later, and you should be sure to keep it. The application should take place in any case before the operations, if you are planning a surgical lipedema therapy performed as a self-pay service at the lipedema specialists of your choice.
Info from Lipocoach: Before the corona pandemic, many patients were lucky and got their application for cost coverage approved through the so-called “approval fiction”. Health insurance companies had to decide on the applications of the insured within a time limit. If this deadline was missed, the requested service was considered approved. Through the reimbursement principle, patients could thus be reimbursed for liposuctions for lipedema. This law was introduced in 2013 to strengthen the rights of the insured and it was hoped that this would lead to more rapid decisions by the health insurance companies. What is quite helpful for us patients and also benefited many lipedema patients, is unfortunately temporarily suspended because of the increased workload and changes due to the corona pandemic.
To note: Unfortunately, it is also not worth changing health insurance companies, because no public health insurance company is allowed to arbitrarily include individual services, such as surgical lipedema therapy, in their benefits catalog.
There are great differences in private health insurance companies, so it is not possible to make a general statement. Each has individual contracts with different conditions and requirements. Therefore, an application should always be made before performing and paying for the operations – it is absolutely worth a try! The prerequisite for this, is 6 months of conservative therapy, which you should prove directly in the application.
Patients in stage III are supposed to have a better chance of having their costs covered by the statutory health insurances. Unfortunately, there are strict conditions and some severely affected patients are left alone with the high costs of several operations.
The prerequisites for coverage of stage III are: a BMI below 35, which is unfortunately the lowest number of patients in the most pronounced stage of lipedema, as well as proof of conservative therapy and weight loss. This includes evidence of completed nutritional counseling and dietary changes, sports programs, as well as certificates and doctors’ letters. This depends on the quality and efforts of the issuing physician. It can therefore be worthwhile to ask several doctors and specialists for lipedema for a doctor’s letter and to explain in detail the burdens caused by the lipedema and the medical indication for surgical therapy. The application for cost coverage in stage III must also be made before the operations. Statutory health insurance companies generally reimburse the costs of lipedema surgery, except for the above-mentioned cases.
Important to note: If your health insurance company agrees to pay for the operations, then only in a practice or clinic with health insurance approval. Therefore, when choosing a surgeon, you must make sure that the health insurance company can be billed. Unfortunately, doctors who are not 100% committed to the treatment of lipedema and cannot guarantee a holistic and radical therapy, as is necessary for lipedema, will also be considered.
Patients with private health insurance have the highest chance of having the costs of surgical therapy covered if they are billed at up to 3.5 times the normal rate. Experience has shown that a large number of patients receive positive feedback from their private health insurer when they apply for reimbursement and submit their doctor’s notes. In addition, privately insured patients are not bound to practices or clinics with health insurance approval.
In summary, it is always worthwhile to apply for cost coverage, to hope that luck is on your side and that you will receive the support from your health insurance that you deserve as a lipedema sufferer.
Currently, not only the awareness about lipedema is changing, but also the bureaucracy behind it. Liposuction for lipedema is to be included in the benefits catalog of health insurance companies; studies are already underway and the need for action is increasing as more and more people are diagnosed with the condition – thank goodness! However, until all that is planned is implemented, it will probably still take quite a while and for many sufferers it will continue to be a struggle to be free of symptoms.
You are not sure in which stage of lipedema you are or whether surgical therapy is an option for you?
Arrange a consultation with our specialists for lipedema!
We will advise you individually and holistically at several locations throughout Germany. To do so, register at the practice or book online at any time via our appointment platform on the website! We look forward to your visit! <3
From LIPOMOTION | Mabelle
From LIPOCOACH® | Pia