Many lipoedema patients know the feeling of helplessness and helplessness only too well. The body aches, and despite various therapeutic approaches, there is often little relief. Surgical removal of the abnormal fatty tissue in lipoedema is often the only effective solution, but the financial burden can initially act as a deterrent.
Since January 2020, it has been possible in Germany to have the costs of lipoedema surgery covered by health insurance under certain conditions.
In this article, we will inform you about the requirements and criteria for the assumption of costs for lipoedema treatment by your health insurance company.
However, we would like to emphasize that LipoClinic Dr. Heck is a private clinic that is not licensed by the health insurance companies, which means that the costs are not covered by the health insurance.
On September 19, 2019, the Federal Joint Committee (GBA) decided that the costs of surgical liposuction can be covered by health insurance under certain conditions. These changes came into effect in January 2020 and are initially valid until December 2024. The exact conditions for such cost coverage for lipoedema depend on the criteria of the individual health insurance companies.
On July 17, 2025, the GBA decided that statutory health insurance will no longer only cover the costs of liposuction for lipoedema in stage 3, but also in stages 1 and 2 under certain conditions. This removes an important previous hurdle.
Nevertheless, strict criteria apply to the assumption of costs for lipoedema: the diagnosis must be made by specially licensed specialists, at least six months of conservative therapy without weight gain is required, and the surgeons also need a special health insurance license.
However, in order for outpatient treatment to be possible as a statutory health insurance benefit, the billing figures still need to be defined in the standardized assessment scale (EBM). The G-BA expects this to be implemented by January 1, 2026, before which the decision must be legally reviewed by the Federal Ministry of Health and published in the Federal Gazette.
Many patients are unsure whether the costs for the treatment of their own lipoedema will be covered by health insurance, as there is often confusion about the requirements and criteria in this context. In the following, we will take a closer look at the necessary requirements and criteria of the health insurance companies to give you an overview.
Health insurance companies will only cover the costs if there is a clear diagnosis of lipoedema. In particular, other diseases with similar symptoms must be ruled out and the following lipoedema symptoms must be identifiable:
Disproportionate increase in fatty tissue on the arms and legs with unaffected hands and feet as well as pain on pressure and touch. In addition, large lobulated and overhanging tissue, so-called dewlaps, which must be at least 5 cm under the skin.
It must also be demonstrated that the treatment is urgently needed by providing concrete evidence of pain, restricted movement and psychological distress. Detailed documentation showing the severe impact of lipoedema on the patient’s quality of life and emphasizing the recesses of the hands and feet is very important.
The diagnosis may only be made by one of the specialist groups approved by the GBA. These include specialists in internal medicine and angiology, specialists in physical and rehabilitative medicine, specialists in skin and sexually transmitted diseases and doctors with additional training in phlebology. A diagnosis made by a private doctor – for example by LipoClinic Dr. Heck – will not be recognized by the health insurance company.
Conservative treatment approaches such as manual lymphatic drainage, compression stockings and exercise therapy must have been exhausted before the procedure before the costs of more extensive measures such as liposuction are covered by health insurance. These measures must have been carried out continuously over a period of at least 6 months and have not brought about any improvement. The ineffectiveness should have been verifiably documented by your attending physician so that liposuction treatment can be prescribed as the next step.
During the six-month conservative therapy phase, it is crucial that the body weight remains stable. Any weight gain during this period may result in the health insurance company refusing to cover the costs of lipoedema treatment.
The background to this is that the health insurance companies want to ensure that the symptoms are actually due to the lipoedema and not to additional weight gain, for example due to a poor diet or lack of exercise. For this reason, it is advisable to pay particular attention to a balanced, anti-inflammatory lipoedema diet, sufficient exercise and consistent compression therapy during this phase.
Another decisive factor is the body mass index (BMI). Health insurance companies often stipulate a BMI below 35 as a prerequisite for cost coverage. A professional consultation and documentation by a doctor is also essential here if the health insurance company is to cover the treatment of lipoedema. If the BMI is between 32 and 35, the waist-to-height ratio (WHtR) is also used to determine whether the weight is mainly due to lipoedema or obesity. If the BMI is above the guideline value of 35, the existing obesity must be treated before liposuction.
In the eighth episode of our LipoClinic Dr. Heck podcast “Made to measure – the lipedema podcast“, our patient Ann-Kathrin talks about her experiences with the disease in combination with obesity.
In addition to the diagnosis, an indication – i.e. the medical justification for the procedure – must also be provided by a licensed surgeon. This step may only be taken six months after the diagnosis at the earliest. Lipoedema surgery can only be carried out at the expense of the health insurance company if both requirements are met.
In order to have the costs of liposuction for lipoedema covered by health insurance, affected patients who meet the criteria and requirements can submit an application. This should emphasize the necessity of the procedure as well as the chronic pain and functional impairments mentioned in the requirements and criteria. This is important as purely cosmetic procedures are not covered by health insurance.
If the health insurance company refuses to cover the costs of your lipoedema, you have the option of lodging an objection. In this case, an expert opinion will be drawn up, usually by a doctor from the MDK. The report on your lipoedema will be sent to the health insurance company. If it is rejected again, an appeals committee will be convened to check whether there are valid reasons for the health insurance fund to cover the costs of your lipoedema.
In the event of a further rejection, there is the option of taking legal action before a social court. Such proceedings are usually free of charge. However, if the case is lost, the claimant must pay their own legal fees.
Although the chances of having the costs of lipoedema treatment covered by health insurance have increased somewhat following the new decision, they depend heavily on whether all formal and medical requirements are met in full. It is therefore important to carefully gather all evidence in advance and seek legal or medical advice if necessary.
The question of whether the costs of lipoedema surgery will be covered by health insurance is understandably one that concerns many lipoedema patients. Liposuction is only covered by health insurance after a confirmed diagnosis by a licensed specialist, six months of conservative therapy without weight gain and compliance with certain BMI and WHtR limits.
As a private clinic, we do not have a health insurance license. This means that we cannot operate on patients whose lipoedema meets the requirements of health insurance at the expense of statutory health insurance companies.
No. LipoClinic Dr. Heck is a private clinic and is not licensed by health insurance companies. We are therefore unable to bill health insurance companies directly. You will receive an invoice from us for your individual treatment contract.
Yes, we can diagnose lipedema as part of our consultation and treat you as usual. However, we no longer issue a diagnosis that is recognized by health insurance companies. An exception only applies to international patients or privately insured patients. The Federal Joint Committee (GBA) has stipulated that a diagnosis valid for health insurance companies may only be made by certain specialists.
Each case is individual. We expect a relatively high demand for cost coverage from health insurance companies. The number of approved doctors and clinics is very limited, but demand is high. Long waiting times may be expected.
As a private lipoedema clinic, we are not affected by the conditions of the court rulingBA decision. There are only a few exclusion criteria for an operation, such as a maximum weight of approx. 130 kg or certain pre-existing conditions. We will be happy to discuss these points with you individually – either by telephone or preferably during a free personal consultation on site.
After a personal consultation, the operation can usually take place within a few weeks, provided your medical history and all preparatory criteria such as flat knit and blood count are met.
Our treatments are provided on the basis of a hospital admission contract, which includes medical treatment, accommodation, meals and nursing care.
This means that we agree fixed flat-rate prices with our patients. This approach was confirmed by the Federal Court of Justice (BGH) in June 2024. The decisive factor here is that our procedures are inpatient treatments – and in these cases, private clinics are not bound by the German Medical Fee Schedule (GoÄ).
For you, this means that you receive full transparency about the costs right from the start and can rest assured that you will not incur any additional fees.
Naturally. You will receive the cell phone number of your surgeon, who will accompany you from the beginning to the end of your journey. A special follow-up appointment is always scheduled after one year.
We will issue you with a certificate of incapacity for work for two weeks after the operation so that you can regenerate optimally.
We also offer tightening via LipoSthetic, but only at our Mülheim an der Ruhr location.
LipoCheck: Your checklist for the liposuction application for lipoedema to the health insurance company. (https://www.lipocheck.de/magazin/checkliste-liposuktion-lipoedem-antrag-krankenkasse-7edac)
Lipoelastic (2025): G-BA decision of 17.07.2025: Liposuction for lipoedema becomes a health insurance benefit for all stages. (https://www.lipoelastic.de/g-ba-beschluss-vom-17-07-2025-liposuktion-bei-lipoedem-wird-fuer-alle-stadien-kassenleistung)
Dr. Thomas Witte is Medical Director of LipoClinic Dr. Heck and a specialist in plastic and aesthetic surgery. With decades of surgical experience and a deep understanding of the individual needs of lipoedema patients, he is one of the leading experts in this field. His focus is on holistic, safe and empathetic care – always with the aim of restoring quality of life.
Medical Director
Specialist in plastic and aesthetic surgery
Specialist in surgery and hand surgeon
