We're Here For You
At ALT, we understand the complexities and challenges of navigating insurance for Lipedema surgery. That's why we have assembled a dedicated team of insurance specialists who are committed to advocating for you and guiding you through the process. Although we may not be in-network with your insurance carrier, we are happy to submit a request for prior authorization and claim submission as a courtesy to our patients.
Functional Capacity Exams (FCE)
We're excited to introduce Functional Capacity Exams (FCE) as a powerful tool in your journey toward understanding and treating Lipedema. Currently available at our Utah center, these comprehensive assessments not only help in securing insurance approval and reimbursement for Lipedema surgery by demonstrating the procedure's medical necessity, but are also beneficial for personal health monitoring. See the FCE FAQ below for more info.
Our Commitment to You
We are here to support you every step of the way and to do everything in our power to increase your chances of insurance approval (within your benefits). Whether it's providing detailed documentation, handling submissions, or appealing denied authorization requests, our team is here to alleviate the uncertainty and frustration of the insurance process, and to ensure that you receive the care and treatment you deserve.
Your Questions Answered
To assist you in understanding the insurance process for Lipedema surgery, we have compiled a comprehensive Lipedema Insurance FAQ section below where you will find answers to commonly asked questions about insurance authorization.
Join Our Patient Support Group
Our dedicated team is always available to assist you with any additional questions or concerns you may have. In addition, ALT maintains an open Patient Guidance and Insurance for Lipedema Facebook Group where current and curious Lipedema patients share questions and experiences.
Understanding Your Insurance Policy
We do our best to make sure that you have approval going into your surgery, however we can not set the fee schedule for your insurance policy. We do not have any control over what is refunded to you the patient, deductibles, co-insurance or what your carrier will deem reasonable and customary. For these reasons we encourage patients check into your policy to learn how your policy works for providers not in your network. It is important to understand your insurance policy is between you and your carrier; each and every policy is unique. This will help all to understand how your insurance works and allow our team to proceed assisting accordingly.
Aside from our dedicated insurance specialists, we also understand the significance of financial planning for Lipedema surgery. That's why we offer financing options to provide support for the cost of the surgery. We recognize that managing the financial aspect of healthcare can be overwhelming, so we strive to provide our patients with as much support and guidance as we can.
We're excited to introduce Functional Capacity Exams (FCE) as a powerful tool in your journey toward understanding and treating Lipedema. Currently available at our Utah center, these comprehensive assessments can significantly boost your chances of securing insurance approval and reimbursement for Lipedema surgery by demonstrating the procedure's medical necessity.
FCE exams provide concrete evidence of functional deficits caused by Lipedema, helping to substantiate your case for insurance recognition and potential approval. By objectively measuring your physical capabilities and limitations, these exams offer insurers a clear picture of how Lipedema impacts your daily life and overall health. Even for those without insurance, an FCE provides valuable documentation of how Lipedema is affecting your physical well-being, which can be crucial for personal health tracking, establishing a baseline for future comparisons, or for potential future insurance submission.
The benefits of undergoing an FCE include:
Our team of specialists will guide you through the FCE process, ensuring that all relevant aspects of your condition are thoroughly documented. We'll then use this valuable information to build a compelling case for your insurance provider, advocating for the approval you need and deserve.
For more detailed information about what to expect during a Functional Capacity Exam, including the specific tests performed and how the results are used, please refer to our FAQ section below. Our dedicated team is always available to answer any additional questions you may have about how a Functional Capacity Exam can support your insurance approval process and how they can provide more insight into how Lipedema affects your life.
What is the cost of a Functional Capacity Exam (FCE)?
The cost of a Functional Capacity Exam at our Utah center is $650. This fee covers the comprehensive assessment, including all tests performed, and the detailed report that will be provided for your insurance submission. While this represents an out-of-pocket expense, many patients find that the potential benefits in terms of improved insurance approval make it a worthwhile investment. We can provide a superbill for you to submit to your insurance for potential reimbursement, which may help offset the cost.
Where does the FCE at ALT take place?
Currently, we offer Functional Capacity Exams to in-person patients at our Utah center. We recognize the importance of making this valuable assessment more widely accessible and are working on expanding our capabilities. In the near future, we hope to offer virtual FCE options, allowing patients from various locations to benefit from this evaluation.
What is a Functional Capacity Exam (FCE)?
A Functional Capacity Exam (FCE), also known as a Physical Performance Test (PPT), is a comprehensive assessment designed to evaluate your current physical and functional performance, specifically focusing on how Lipedema impacts your daily activities and overall well-being.
What is the purpose of an FCE?
The primary purpose of an FCE is to gather objective data about your physical capabilities and limitations. This information is crucial in demonstrating the medical necessity of Lipedema surgery to insurance providers, potentially improving your chances of insurance approval.
What does an FCE involve?
During the FCE, we will conduct a series of tests and assessments, including:
We will also ask questions throughout the testing to gain a comprehensive understanding of how Lipedema has impacted your function and quality of life.
What specific tests are performed during an FCE?
The FCE includes a wide range of tests to provide a thorough evaluation:
How will the FCE results be used?
Following the exam, we will prepare a detailed report of our findings based on your specific test results. This report is designed to be submitted to your insurance company as supporting evidence for your case. We will provide the best available evidence to aid you in obtaining insurance approval and reimbursement for your procedures.
Will I receive guidance on using the FCE results?
Yes, absolutely. We will guide you on what should be included in your letter to the insurance company to make the strongest case possible. Our team is committed to helping you leverage the FCE results effectively in your insurance process.
How long does an FCE take?
The duration of an FCE can vary depending on individual circumstances, but typically it takes about 1 hour to complete all the necessary tests and assessments.
Is there any preparation required for an FCE?
We recommend wearing comfortable clothing and shoes suitable for light physical activity. It's also important to bring any assistive devices you typically use, such as canes or braces.
Can I get an FCE if I've already submitted an insurance claim?
Yes, an FCE can be beneficial even if you've already submitted a claim. The objective data from the exam can strengthen your case, especially if you're in the process of appealing a denied claim.
Yes, starting March 15th 2023, Dr. Amron is an in-network provider with Aetna. If you're interested in scheduling a consultation with Dr. Amron, our team is here to guide you through the process and answer any questions you may have. We want you to feel supported and confident in your decision to pursue treatment.
We can submit our recommended procedures to most PPO insurance companies, and if you have Aetna, we are proud to share that Dr. Amron is an in-network provider as of March 15th, 2023. This means that you can expect to only be responsible for your deductible, co-insurance, and operating room/anesthesia fees when receiving Advanced Lipedema Treatment with Dr. Amron.
We understand that the cost of treatment can be a concern, especially for those without insurance. Our expert Lipedema surgeons will work with you to create a personalized treatment plan that takes into account your specific needs and financial resources. We'll provide you with a detailed estimate of the costs involved upfront, so you can make an informed decision about your care.
The amount reimbursed depends on your specific insurance policy, making it difficult to determine coverage until after your surgery is complete and billed. However, we're committed to working with you to find the best possible outcome for your needs.
Approximately 80% of the surgeries for patients with PPO insurance are either approved or partially approved. However, it's important to keep in mind that insurance coverage can be unpredictable, and there's no guarantee that your surgery will be approved. Rest assured, we're committed to working with you to explore all available options and ensure that your healthcare experience is as stress-free as possible.
At ALT, we understand the complexities and challenges patients face when navigating insurance benefits for partial or full coverage for Lipedema surgery. That's why we have assembled a dedicated team of insurance specialists who are committed to advocating for you and guiding you through the process.
We are here to support you every step of the way and to do everything in our power to increase your chances of insurance approvals within your benefits. Whether it's providing detailed documentation, handling submissions, or appealing denied claims, our team is here to alleviate the uncertainty and frustration of the insurance process, and to ensure that you receive the care and treatment you deserve.
We understand that navigating insurance can be complicated and frustrating. At this time, treatment at ALT can only be submitted to PPO insurance plans, and we cannot accept HMO, Kaiser, Medicare, or TRICARE. We understand the importance of affordable and accessible healthcare, and we are committed to exploring all possible options to make our services more accessible to all patients in the future.
At no cost to you, our dedicated insurance team is here to support you in the process of obtaining coverage for your Lipedema surgery. The process of securing insurance benefits toward procedures can be overwhelming, so our team is committed to making it as stress-free as possible. By providing you with a detailed insurance guide and handling all necessary submissions, prior authorizations, and appeals, we will ensure that your case is presented in the strongest way possible to your insurance company. Our experienced insurance team will work closely with you every step of the way, but keep in mind that as the patient and policyholder, you are also an important advocate for your own coverage. We will encourage you to stay in communication with your insurance company and provide you with all the necessary documentation. Together, we will do everything we can to support you.
We understand the uncertainty and frustration of navigating insurance coverage for Lipedema surgery. When we think of the word “covered” we think this means that the procedures with be “covered” at 100%. It’s important to have an understanding of your benefits and how they relate to coverage of the procedures. While there has been progress in the recognition of Lipedema by insurance companies, getting approvals and coverage can still be a challenge. However, we want to assure you that our experienced insurance team is here to stand up for you and improve your chances of coverage approval. At no expense to you, we will work closely with you to create a comprehensive case that demonstrates the medical necessity of your surgery. Though we cannot guarantee approval, we promise to be your dedicated advocate throughout the entire process.
Our insurance team has created a comprehensive guide to ensure that your unique case is presented in the strongest way possible to your insurance company. This guide includes all the important information and documentation that insurance providers typically require. By following this guide, you'll be taking the first step toward getting coverage. Talk to our team to inquire about our Lipedema Insurance Guide today, as we encourage you to start gathering the necessary information as soon as possible. Remember, we're here to help you and make this process as stress-free as possible.
In order for a patient's secondary insurance to accept and process a claim, they will require an Explanation of Benefits and a response from Medicare. Because we do not participate with Medicare, we do not have the option to file claims to Medicare on behalf of the patient.
We do not accept Kaiser, Medicare, Medi-Cal (CA), or Medi-Caid (other states)
As much as we wish we could, changes will need to be made with the insurance carrier and the existing authorization. Additionally, a call may need to be placed with the existing office as there are instances when only the previous doctor can remove an existing authorization before anew doctor can request.
Due to the complicated nature of insurance, our office requires that all fees be collected upfront.
Since we need to provide your insurance company with an official diagnosis and consultation report from your ALT physician/provider, receiving a pre-approval prior to the consultation is unfortunately not possible.
Your most favorable option would be to choose either:
1) Most PPO plans with Out-of-Network coverage
2) Most other plans that allow for an Out-of-Network provider to treat you
A “Pre-Determination” is the insurance company reviewing that this is a surgical treatment that is covered under your health plan. An “Authorization” is your insurance company reviewing this treatment for possible coverage as they confirm that you have met the necessary medical requirements
Our office protocol is to collect all fees upfront, however, we will submit a claim to your insurance company as a courtesy. Because we don’t have a way of knowing what amounts your insurance will provide exactly, we are given a % of UCR (Usual, Customary, and Reasonable) and this can be based on several factors by each insurance carrier
Minimum 3 months, however, 6+ months is preferred.
Our office has found that Conservative Measures are becoming more and more a requirement to prove that the medical necessity has been met prior to deciding on surgical intervention.
It is very helpful to obtain a Functional Capacity Evaluation prior to a decision for surgery — it will give you the best chance of insurance coverage
Unfortunately, not all PPO’s have Out-of-Network coverage due to employer exclusions. This is one reason why it is important to verify insurance coverage prior to consultation. We will help you do this!
