This week we’ve been learning a lot about lipedema through conversation with Dr. David Amron on his surgical practice and his multi-system approach to lipedema treatment.
In the conclusion to this three-part series, Dr. Amron explains his consultation process and the ever-frustrating issue of insurance coverage. He also shares some final thoughts on the incredible influence lipedema patients have had on his own life, and what the community means to him.
Interview has been edited due to length.
THE LYMPHIE LIFE: I did have a question or two just about the logistics of the process for patients to have an initial consultation with you.
DR. AMRON: Probably only about 10% of my patients come from the Southern California area, maybe less than that. Most come from outside California – most people are flying in internationally, with a lot coming from Canada, Europe and faraway places such as India, New Zealand and South Africa.
The process that’s currently in place is that, for patients that are not in the Southern California area, I do a photo-phone consultation or a Skype consultation with a patient. Photographs are sent to me first to evaluate, and the photographs are taken in a certain way. They can be taken at home, but they need to follow instructions of how I want to see their body. They’ll fill out a whole questionnaire about symptoms and their medical history and all that – I’ll review those, and I’ll get on the phone with them and do a consultation, which is usually about 30 minutes. I’ll ask more questions, then I’ll talk about lipedema itself – the disease, my surgical approach – and then we’ll finally get on in terms of a specific treatment plan for their case, whether it’s one surgery, two surgeries, or three surgeries.
I generally group things, so I’ll do the circumferential calves, ankles, and arms as one surgery, and the thighs circumferentially as a separate surgery. I’ll talk about what my treatment plan is and then my surgical coordinator will follow up with the patient in terms of arranging everything when the patient decides to move ahead. The patient will do their laboratory tests and medical clearance out where they are, and we’ll start to arrange all their garments. They will arrive here the day before the surgery – I will meet them in person, review the treatment plan with them, see them and evaluate their body once again. The surgery will be the next day.
Most of my surgeries are about four hour surgeries. They’ll then usually go back to where they’re staying with their responsible friend or family member [to recover] – sometimes if they’re very complicated or older, and I might send them to an aftercare facility or with an RN. I’ll see them the next day for a post-operative check. They’ll do MLD therapy in Los Angeles usually twice: the day after surgery and two days after that. And then they either fly home four days later or, if they need a second surgery, we repeat the process a week later, and they’ll go home four days after that.
TLL: I know insurance is always a tricky thing when it comes to lipedema and lymphedema, but are the surgeries generally covered by insurance?
DR. A: You know, it’s complicated, it’s continually frustrating. We’re all frustrated by it: I’m frustrated, the patients are definitely frustrated. Everybody feels badly about it. I think insurance companies are generally not stepping up to the plate pretty much across the board with things. Currently I’m out of network, and I have to be out of network to be able to substantiate medical necessity and to be able to go to bat for patients. I’m looking at possibly getting back into network again in some way, but it’s still a very challenging, frustrating thing. The few surgeons around the country that do this like myself have also found that it’s very challenging to get it covered by insurance.
In my experience, about 2-3% of patients are getting covered by insurance, and it’s not always a very complicated patient – sometimes it’s even a Stage I or II patient that gets covered, and sometimes your Stage IV patient who comes in a wheelchair that can barely walk gets rejected.
TLL: Do you offer a payment plan or sliding scale for patients to work with them on the surgery fees?
DR. A: There’s financing that we have available through the practice, so we’ll work with patients and help arrange financing for them. Generally I charge per surgery: I spend a long time with each surgery, so my fees are basically commensurate with that, and that includes all the pre-care and post-care. We help patients with financing, and we also try to assist them in terms of coverage, too.
TLL: Nice, that’s really important. I think that was all of my questions for you – do you have anything that you’d like to add?
DR. A: I believe that we all have a responsibility to continue to increase awareness for this disease. I think that doctors who know about it should continue to educate people and new patients that begin to learn about it, should educate other people – that goes on, which is so nice to see. It really is kind of what we began this whole conversation with: it’s a pretty great community.
TLL: It is! I was very struck by that at the [Fat Disorders Research Society Conference], because I’ve never really spent time around lipedema patients before. It was such a positive sisterhood among the patients, which was really nice to see – very supportive.
DR. A: Absolutely. It’s not just the patients – I mean, the families, too. You have to realize – and I see it every day – people are flying across the country, around the world, with their family members [for treatment]. The family members are very involved in this, whether it’s a husband or it’s a child or it’s a mother – and many times they’re the ones who actually found out about it and made the patient aware of it. Lipedema has been so ignored, and it’s amazing most doctors don’t know about it. I say to them, all you need to do is come spend a week at my practice and just start to appreciate what this disease really is.
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TLL: I can’t even count how many times I’ve had to explain to doctors that I’ve seen – I’ve had lymphedema since birth but I wasn’t diagnosed until I was fourteen because no one knew what it was, and it’s baffling. It hasn’t gotten much better.
DR. A: You know for me just personally, it’s so gratifying in this stage in my career to be involved in lipedema. I’ve been in practice for over twenty years and for me, as a cosmetic surgeon, especially in Beverly Hills, to get back to disease treatment and make such a drastic difference in people’s lives is so gratifying to me. And it’s also very honoring to me, a whole other level of fulfillment.
TLL: I think you’re quite literally saving lives in the sense that these people are probably at their wit’s end with the burden of daily life, where just being out in public is so hard for a lot of them. To finally have someone go to bat and do this for them is significant.
DR. A: Yeah – at that meeting in Salt Lake City, there was a patient of mine that I did years ago named Jasna. When I saw her she said – this is after four years – she said, “Dr. Amron, every night when I go to bed I pray for you. You have no idea how you’ve changed my life.” So – you know, it’s just incredibly fulfilling.
TLL: It’s amazing work you’re doing for these people.
DR. A: I feel like – again – I feel like it came to me. I feel blessed myself from the disease or I guess the community finding me. It gives back to me a lot, it really does.
It’s always a pleasure to speak with medical professionals who are passionate and dedicated not only to disease treatment, but to the patients as well. The Lymphie Life would like to thank Dr. Amron for graciously granting this interview, and a special thanks to the staff at The Roxbury Institute for coordinating the opportunity!
To learn more about Dr. Amron or schedule a consultation, please visit amronmd.com. You can also connect with Dr. Amron on Instagram, Facebook, Twitter, Google+, and YouTube, and follow the Lipedema Society on Facebook and Instagram.
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