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Insurance companies deny coverage to treat a painful, debilitating condition, wrongfully labeling the treatment as purely “cosmetic”

Lipedema is a serious medical condition that affects nearly 11% of women across the world. Despite the debilitating nature of the condition and the availability of effective treatments, many people who suffer from Lipedema are unable to access therapeutic procedures due to the overwhelming cost, or if they manage to do so are left in serious debt when forced to pay for treatment out of pocket. Insurance companies wrongfully label Lipedema treatments as “cosmetic” in order to deny coverage. If you suffer from Lipedema or another similar condition whose treatments are unfairly denied as cosmetic, you should speak to an experienced insurance bad faith attorney to get the coverage you deserve for the medical treatment you need.

What is Lipedema?

Lipedema is a disorder characterized by the enlargement of the legs due to excess fat deposits beneath the skin. The disease almost exclusively affects women, but it is very common; the National Institute of Health (NIH) reports that it affects an estimated 11% of adult women worldwide. The symptoms vary by person but typically involve abnormal deposits of body fat in both legs, extending from the buttocks to the ankles. The disorder is progressive, such that while many sufferers have a normal appearance from the waist-up in the early stages of Lipedema, as the disorder progresses they may experience similar enlarging of the torso, abdomen, and upper extremities.

Is Lipedema Harmful?

Lipedema is not mere weight gain in particular parts of the body. Lipedema sufferers cannot simply shed the pounds by changes in lifestyle or even by taking other extreme weight loss measures. Moreover, the disorder is characterized by easy bruising, sensitivity to touch, and serious pain in all affected extremities. The legs, and later other body parts, grow rapidly, often in connection with hormones or stress, and can eventually lead to disabling the patient. The disease is degenerative, disfiguring, extremely painful, and crippling.

Lipedema is a progressive disease that occurs in stages. In Stage 3 lipedema, large extrusions of skin and fat tissue appear on the thighs and around the knees, causing gross deformations, pain and limited mobility. Stage 4 lipedema is known as lymphedema, as blockage in the lymphatic system prevents lymph fluid from draining naturally, causing painful swelling in one or more arms or legs.

Are There Treatments for Lipedema?

There are various treatments available that can effectively manage and mitigate the problems associated with Lipedema. Known Lymphedema (Stage 4 Lipedema) treatments include complete decongestive therapy (CDT), which involves compression garments, bandaging, and manual lymphatic drainage. For other stages of Lipedema, the recommended treatment is specialized suction lipectomy (tumescent liposuction) to remove the diseased subcutaneous adipose tissue fat. CDT may also be used before and after liposuction to manage the condition.

The specialized liposuction is known to be effective and differs from typical cosmetic liposuction. The procedure involves injecting the affected site with epinephrine and lidocaine followed by the surgical removal of affected subcutaneous fat cells. It removes a more limited portion of fat in the affected areas and involves more gentle, directed techniques. The procedure carries risks and is not recommended by doctors lightly; however, it is known to effectively treat the pain, disfigurement, and disability caused by Lipedema.

Why Are Insurance Companies Denying Lipedema Treatments?

Liposuction for Lipedema can cost tens of thousands of dollars and require multiple surgeries. Unfortunately for patients who suffer from this debilitating condition, insurance companies are extremely reluctant to cover the costs of any procedure they can plausibly deem as “cosmetic,” such as liposuction. Cosmetic procedures are those that only affect the appearance of the patients and carry no other medicinal benefit. Many insurance companies have blanket policies that label all liposuction as cosmetic, refusing to account for patients who suffer from legitimate disorders (like Lipedema) that liposuction can actually help.

By refusing to look at conditions like Lipedema on a case-by-case basis, or finding some other excuse to deny the treatments, these companies are betraying their policyholders in order to avoid coverage and reimbursements. The bad faith insurance lawyers at Gianelli & Morris are dedicated to ending this practice, as these sorts of denials blatantly violate California law that pertains to the health insurance coverage of reconstructive surgery.

Experienced Legal Help in Los Angeles and California Statewide

If your insurance company is wrongfully denying you coverage for your Lipedema treatments, you need the help of an established, passionate, and seasoned California insurance law attorney. Contact the bad faith insurance lawyers at Gianelli & Morris, who have been fighting on behalf of California policyholders since 1979. Attorneys at Gianelli & Morris have already brought multiple lawsuits against Anthem, Inc. and Anthem Blue Cross of California on behalf of women who were wrongfully denied coverage for tumescent liposuction to treat their Lipedema. Our filings to date have included an individual bad faith claim as well as a class action aimed at forcing Anthem to change its position regarding coverage of this important treatment. We can fight for you, too. Policyholders have rights and deserve coverage for the treatment of legitimate medical issues. We can help you get the coverage you deserve.

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