S374

An Act concerning health insurance coverage for the treatment of lipedema and supplementing various parts of the statutory law.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. a. A hospital service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the subscriber’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the subscriber’s surgeon, and pre-and post-lipectomy appointments with the subscriber’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, a hospital service corporation shall only require a subscriber to provide documentation from the subscriber’s physician diagnosing the subscriber with lipedema and, if applicable, documentation from the subscriber’s surgeon that includes photographs of the subscriber that support the diagnosis and information on the number of lipectomies the subscriber’s surgeon deems medically necessary. If a hospital service corporation denies coverage for expenses incurred for the treatment of lipedema, the hospital service corporation shall provide the subscriber with a detailed explanation of the reason for the denial. A hospital service corporation shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the subscriber submitted pursuant to this subsection.

c. A hospital service corporation shall provide coverage for the total number of lipectomies deemed medically necessary by the subscriber’s surgeon and shall not require a subscriber’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the subscriber during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the subscriber’s surgeon receives the prior authorization and a hospital service corporation shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the subscriber continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or subscriber; and (3) there has not been a material change in the clinical circumstances or condition of the subscriber. On receipt of information documenting a prior authorization from the subscriber or the subscriber’s surgeon, a hospital service corporation shall honor a prior authorization granted to a subscriber for a lipectomy by the subscriber’s previous carrier for the remainder of the duration of the prior authorization.

e. The benefits provided by this section shall be provided to the same extent and with the same deductibles, coinsurance, and other cost sharing as apply to similar services under the contract and shall be consistent with the current standard of care for lipedema.

f. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

2. a. A medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the subscriber’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the subscriber’s surgeon, and pre-and post-lipectomy appointments with the subscriber’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, a medical service corporation shall only require a subscriber to provide documentation from the subscriber’s physician diagnosing the subscriber with lipedema and, if applicable, documentation from the subscriber’s surgeon that includes photographs of the subscriber that support the diagnosis and information on the number of lipectomies the subscriber’s surgeon deems medically necessary. If a medical service corporation denies coverage for expenses incurred for the treatment of lipedema, the medical service corporation shall provide the subscriber with a detailed explanation of the reason for the denial. A medical service corporation shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the subscriber submitted pursuant to this subsection.

c. A medical service corporation shall provide coverage for the total number of lipectomies deemed medically necessary by the subscriber’s surgeon and shall not require a subscriber’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the subscriber during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the subscriber’s surgeon receives the prior authorization and a medical service corporation shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the subscriber continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or subscriber; and (3) there has not been a material change in the clinical circumstances or condition of the subscriber. On receipt of information documenting a prior authorization from the subscriber or the subscriber’s surgeon, a medical service corporation shall honor a prior authorization granted to a subscriber for a lipectomy by the subscriber’s previous carrier for the remainder of the duration of the prior authorization.

f. This section shall apply to those medical service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

3. a. A health service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the subscriber’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the subscriber’s surgeon, and pre-and post-lipectomy appointments with the subscriber’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, a health service corporation shall only require a subscriber to provide documentation from the subscriber’s physician diagnosing the subscriber with lipedema and, if applicable, documentation from the subscriber’s surgeon that includes photographs of the subscriber that support the diagnosis and information on the number of lipectomies the subscriber’s surgeon deems medically necessary. If a health service corporation denies coverage for expenses incurred for the treatment of lipedema, the health service corporation shall provide the subscriber with a detailed explanation of the reason for the denial. A health service corporation shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the subscriber submitted pursuant to this subsection.

c. A health service corporation shall provide coverage for the total number of lipectomies deemed medically necessary by the subscriber’s surgeon and shall not require a subscriber’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the subscriber during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the subscriber’s surgeon receives the prior authorization and a health service corporation shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the subscriber continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or subscriber; and (3) there has not been a material change in the clinical circumstances or condition of the subscriber. On receipt of information documenting a prior authorization from the subscriber or the subscriber’s surgeon, a health service corporation shall honor a prior authorization granted to a subscriber for a lipectomy by the subscriber’s previous carrier for the remainder of the duration of the prior authorization.

f. This section shall apply to those health service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

4. a. An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the insured’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the insured’s surgeon, and pre-and post-lipectomy appointments with the insured’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, an individual health insurance policy shall only require an insured to provide documentation from the insured’s physician diagnosing the insured with lipedema and, if applicable, documentation from the insured’s surgeon that includes photographs of the insured that support the diagnosis and information on the number of lipectomies the insured’s surgeon deems medically necessary. If an individual health insurance policy denies coverage for expenses incurred for the treatment of lipedema, the individual health insurance policy shall provide the insured with a detailed explanation of the reason for the denial. An individual health insurance policy shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the insured submitted pursuant to this subsection.

c. An individual health insurance policy shall provide coverage for the total number of lipectomies deemed medically necessary by the insured’s surgeon and shall not require an insured’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the insured during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the insured’s surgeon receives the prior authorization and an individual health insurance policy shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the insured continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or insured; and (3) there has not been a material change in the clinical circumstances or condition of the insured. On receipt of information documenting a prior authorization from the insured or the insured’s surgeon, an individual health insurance policy shall honor a prior authorization granted to an insured for a lipectomy by the insured’s previous carrier for the remainder of the duration of the prior authorization.

e. The benefits provided by this section shall be provided to the same extent and with the same deductibles, coinsurance, and other cost sharing as apply to similar services under the policy and shall be consistent with the current standard of care for lipedema.

f. This section shall apply to those individual health insurance policies in which the individual health insurance policy has reserved the right to change the premium.

5. a. A group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the insured’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the insured’s surgeon, and pre-and post-lipectomy appointments with the insured’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, a group health insurance policy shall only require an insured to provide documentation from the insured’s physician diagnosing the insured with lipedema and, if applicable, documentation from the insured’s surgeon that includes photographs of the insured that support the diagnosis and information on the number of lipectomies the insured’s surgeon deems medically necessary. If a group health insurance policy denies coverage for expenses incurred for the treatment of lipedema, the group health insurance policy shall provide the insured with a detailed explanation of the reason for the denial. A group health insurance policy shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the insured submitted pursuant to this subsection.

c. A group health insurance policy shall provide coverage for the total number of lipectomies deemed medically necessary by the insured’s surgeon and shall not require an insured’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the insured during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the insured’s surgeon receives the prior authorization and a group health insurance policy shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the insured continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or insured; and (3) there has not been a material change in the clinical circumstances or condition of the insured. On receipt of information documenting a prior authorization from the insured or the insured’s surgeon, a group health insurance policy shall honor a prior authorization granted to an insured for a lipectomy by the insured’s previous carrier for the remainder of the duration of the prior authorization.

e. The benefits provided by this section shall be provided to the same extent and with the same deductibles, coinsurance, and other cost sharing as apply to similar services under the policy and shall be consistent with the current standard of care for lipedema.

f. This section shall apply to those group health insurance policies in which the group health insurance policy has reserved the right to change the premium.

6. a. An individual health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the covered person’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the covered person’s surgeon, and pre-and post-lipectomy appointments with the covered person’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, an individual health benefits plan shall only require an insured to provide documentation from the covered person’s physician diagnosing the covered person with lipedema and, if applicable, documentation from the covered person’s surgeon that includes photographs of the covered person that support the diagnosis and information on the number of lipectomies the covered person’s surgeon deems medically necessary. If an individual health benefits plan denies coverage for expenses incurred for the treatment of lipedema, the individual health benefits plan shall provide the covered person with a detailed explanation of the reason for the denial. An individual health benefits plan shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the covered person submitted pursuant to this subsection.

c. An individual health benefits plan shall provide coverage for the total number of lipectomies deemed medically necessary by the covered person’s surgeon and shall not require a covered person’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the covered person during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the covered person’s surgeon receives the prior authorization and an individual health benefits plan shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the covered person continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or covered person; and (3) there has not been a material change in the clinical circumstances or condition of the covered person. On receipt of information documenting a prior authorization from the covered person or the covered person’s surgeon, an individual health benefits plan shall honor a prior authorization granted to a covered person for a lipectomy by the covered person’s previous carrier for the remainder of the duration of the prior authorization.

e. The benefits provided by this section shall be provided to the same extent and with the same deductibles, coinsurance, and other cost sharing as apply to similar services under the health benefits plan and shall be consistent with the current standard of care for lipedema.

f. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.

7. a. A small employer health benefits plan that provides hospital and medical expense benefits and is delivered, issued, executed or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the covered person’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the covered person’s surgeon, and pre-and post-lipectomy appointments with the covered person’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, a small employer health benefits plan shall only require a covered person to provide documentation from the covered person’s physician diagnosing the covered person with lipedema and, if applicable, documentation from the covered person’s surgeon that includes photographs of the covered person that support the diagnosis and information on the number of lipectomies the covered person’s surgeon deems medically necessary. If a small employer health benefits plan denies coverage for expenses incurred for the treatment of lipedema, the small employer health benefits plan shall provide the covered person with a detailed explanation of the reason for the denial. A small employer health benefits plan shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the covered person submitted pursuant to this subsection.

c. A small employer health benefits plan shall provide coverage for the total number of lipectomies deemed medically necessary by the covered person’s surgeon and shall not require a covered person’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the covered person during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the covered person’s surgeon receives the prior authorization and a small employer health benefits plan shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the covered person continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or covered person; and (3) there has not been a material change in the clinical circumstances or condition of the covered person. On receipt of information documenting a prior authorization from the covered person or the covered person’s surgeon, a small employer health benefits plan shall honor a prior authorization granted to a covered person for a lipectomy by the covered person’s previous carrier for the remainder of the duration of the prior authorization.

e. The benefits provided by this section shall be provided to the same extent and with the same deductibles, coinsurance, and other cost sharing as apply to similar services under the health benefits plan and shall be consistent with the current standard of care for lipedema.

f. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.

8. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance on or after the effective date of this act, shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the enrollee’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the enrollee’s surgeon, and pre-and post-lipectomy appointments with the enrollee’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, a health maintenance organization plan shall only require an enrollee to provide documentation from the enrollee’s physician diagnosing the enrollee with lipedema and, if applicable, documentation from the enrollee’s surgeon that includes photographs of the enrollee that support the diagnosis and information on the number of lipectomies the enrollee’s surgeon deems medically necessary. If a health maintenance organization denies coverage for expenses incurred for the treatment of lipedema, the health maintenance organization shall provide the enrollee with a detailed explanation of the reason for the denial. A health maintenance organization shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the enrollee submitted pursuant to this subsection.

c. A health maintenance organization shall provide coverage for the total number of lipectomies deemed medically necessary by the enrollee’s surgeon and shall not require an enrollee’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the enrollee during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the enrollee’s surgeon receives the prior authorization and a health maintenance organization shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the enrollee continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or enrollee; and (3) there has not been a material change in the clinical circumstances or condition of the enrollee. On receipt of information documenting a prior authorization from the enrollee or the enrollee’s surgeon, a health maintenance organization shall honor a prior authorization granted to an enrollee for a lipectomy by the enrollee’s previous carrier for the remainder of the duration of the prior authorization.

f. This section shall apply to those contracts for health care services under which the health maintenance organization has reserved the right to change the schedule of charges for enrollee coverage.

9. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the covered person’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the covered person’s surgeon, and pre-and post-lipectomy appointments with the covered person’s physician and surgeon.

b. To receive coverage for expenses incurred for the treatment of lipedema, a contract purchased by the commission shall only require a covered person to provide documentation from the covered person’s physician diagnosing the covered person with lipedema and, if applicable, documentation from the covered person’s surgeon that includes photographs of the covered person that support the diagnosis and information on the number of lipectomies the covered person’s surgeon deems medically necessary. If a contract purchased by the commission denies coverage for expenses incurred for the treatment of lipedema, the contract purchased by the commission shall provide the covered person with a detailed explanation of the reason for the denial. A contract purchased by the commission shall not deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the covered person submitted pursuant to this subsection.

c. A contract purchased by the commission shall provide coverage for the total number of lipectomies deemed medically necessary by the covered person’s surgeon and shall not require a covered person’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the covered person during a lipectomy in order to receive coverage.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the covered person’s surgeon receives the prior authorization and a contract purchased by the commission shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the covered person continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or covered person; and (3) there has not been a material change in the clinical circumstances or condition of the covered person. On receipt of information documenting a prior authorization from the covered person or the covered person’s surgeon, a contract purchased by the commission shall honor a prior authorization granted to a covered person for a lipectomy by the covered person’s previous carrier for the remainder of the duration of the prior authorization.

10. a. The School Employees’ Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act that provides hospital and medical expense benefits shall provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage shall be provided shall include compression garments for all of the covered person’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the covered person’s surgeon, and pre-and post-lipectomy appointments with the covered person’s physician and surgeon.

d. Notwithstanding the provisions of any law, rule, or regulation to the contrary, prior authorization for a lipectomy shall be valid for a period of one year from the date the covered person’s surgeon receives the prior authorization and a contract purchased by the commission shall not revoke, limit, condition, or restrict a prior authorization within that period if (1) the covered person continues to be eligible for coverage; (2) the clinical information provided at the time the prior authorization request was made has not been misrepresented by the surgeon or covered person; and (3) there has not been a material change in the clinical circumstances or condition of the covered person. On receipt of information documenting a prior authorization from the covered person or the covered person’s surgeon, a contract purchased by the commission shall honor a prior authorization granted to a covered person for a lipectomy by the covered person’s previous carrier for the remainder of the duration of the prior authorization.

11. This act shall take effect on the first day of the sixth month next following enactment and shall apply to contracts entered into or renewed after that date.

STATEMENT

This bill requires health insurers (health, hospital and medical service corporations, commercial individual and group health insurers; health maintenance organizations, health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs, the State Health Benefits Program, and the School Employees’ Health Benefits Program) to provide coverage for expenses incurred for the treatment of lipedema. The expenses for which coverage is to be provided include compression garments for all of the covered person’s affected extremities, manual lymphatic drainage, medical nutrition therapy, mental health care, lipectomy that is determined to be medically necessary by the covered person’s surgeon, and pre-and post-lipectomies appointments with the covered person’s physician and surgeon.

The bill requires a covered person to provide a carrier with documentation from the covered person’s physician diagnosing the covered person with lipedema and, if applicable, documentation from the covered person’s surgeon that includes photographs of the covered person that support the diagnosis and information on the number of lipectomies the covered person’s surgeon deems medically necessary.

Under the bill, a carrier is to provide coverage for the total number of lipectomies deemed medically necessary by the covered person’s surgeon and shall not require a covered person’s surgeon to remove less fat than the surgeon deems medically necessary to be removed from the covered person during lipectomy in order to receive coverage. If a carrier denies coverage for expenses incurred for the treatment of lipedema, the carrier is to provide the covered person with a detailed explanation of the reason for the denial. A carrier cannot deny coverage for expenses incurred for the treatment of lipedema solely based on photographs of the covered person submitted pursuant to the bill.

Additionally, the bill provides that prior authorization granted by a carrier for a lipectomy is valid for a period of one year from the date the covered person’s surgeon receives the prior authorization. A carrier is required to honor a prior authorization granted to a covered person for a lipectomy by the covered person’s previous carrier for the remainder of the duration of the prior authorization. Coverage is to be provided consistent with the current standard of care for lipedema.

Lipedema is a chronic, progressive condition characterized by abnormal and often painful fat accumulation in specific areas of the body. The condition does not have a cure, but lipectomy can help remove fat and reduce the pain associated with the condition.