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August 3, 2001

Insurance/Costs

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Question from Cleveland, Ohio, USA:

I am a 30 year old, who has had diabetes since the age of seven, and have severe atrophy on my legs which began when I was young causing “shelves” in my legs. I have not given injections in my legs for over 10 years, but after giving birth a few months ago, the atrophy worsened.

I saw a plastic surgeon who said that my legs could be liposuctioned, but my right leg could not be fixed completely because the “shelf” prevents the fat from being evenly distributed causing a bulge. Since the procedure is cosmetic, I would have to pay cash for the liposuction. Do you know of any other procedure that can be done? Is there any way to persuade my insurance company into paying a portion of the liposuction?

Answer:

From: DTeam Staff

I have to say that I am not an expert in lipoatrophy as severe as you have described. I would suggest a second opinion from another plastic surgeon. This may help to determine whether this is a usual practice or something your original surgeon was not familiar/comfortable with.

As far as insurance payment, this is an ongoing issue for individuals who have “cosmetic” problems which are way out of the ordinary and impact overall health. I would suggest you speak with other individuals about this. You can speak with your human resource representative, the insurance oversight board in your state, an attorney, or the insurance company for more information relating to your case.

JTL
Additional comments from David Holtzman, Director of Government Affairs,
Am. Assoc. of Diabetes Educators:
Medical insurance and HMO contracts typically exclude procedures that are thought to be “cosmetic”. In order for an insurer to cover a procedure there must be a clear causal relationship to the physical manifestation of disease or trauma. In your situation you must make a case to your insurer that there is a medical reason that you must have the liposuction procedure. To do this you will need to have a physician document that because of this condition your legs cause you pain, do not function properly, or are the result of some other physical manifestation of disease.

DH