Documented Medical Indication for Insurance for Liposuction/Buffalo Hump
Sep 5, 2004
I am an HIV/AIDS treater and have had excellent results with liposuction for painful, uncomfortable cervical neckpads in HIV patients, some of whom are not overweight. As Liposuction ordinarily and commonly is used for cosmetic improvement in exogenous obesity, it is not a 'covered' treatment; however for HIV/AIDS patients whose cervical discomfort and neck disfigurement is unique to HIV/AIDS and whose psychological effects of large cervical fat pads can produce great debility, what resources or statements can you suggest to support managed care insurors to undrwrite such treatment which is not purly 'cosmetic?' Thank you...
Stanley Bodner, MD FACP in TN
Response from Dr. Young
Dr. Bodner, thanks for your question and sorry for the delay in reply.
I've shared your experience in getting insurance to cover surgical treatments for lipodystrophy. However, since both lipoatrophy and lipoaccumulation are clearly complications of HIV disease or its treatment (and there is a ICD-9 code for lipodystrophy), I have made successful cases for coverage with some companies. This typically requires documentation of the duration and extent of the symptoms as well as a forceful argument that cervical fat accumulation is a HIV complication. Treatment of HIV complications thereof is within the usual and customary coverage of most plans.
When pushed, it is often useful to have a discussion with the medical director of the managed care plan directly (rather than the usual claims representatives).
Hope this helps. Let us know (either here or at TheBodyPro.com) how this turns out for you and your patients.
Thanks for reading. BY
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