Insurance Company Denies $35,000 Surgery to a Mom of 2 Living with ‘Painful Condition’ — and This Was Their Excuse

A Utah mom living with a painful fat disorder says her insurance company denied the surgery she needs — allegedly claiming it wasn’t “medically necessary” and that she didn’t meet one specific symptom requirement.

Aurora McCausland, a mother of two and a well-known influencer from West Valley City recognized for her DIY home content, shared her story in a viral video. She explained that her insurance provider at the time, Cigna Healthcare, denied coverage for surgery to treat lipedema, a condition she says she was diagnosed with a year prior.

According to the Cleveland Clinic, lipedema is a chronic disorder marked by “abnormal fat buildup on both sides of your lower body, usually in your legs.” It’s resistant to diet and exercise and can “cause pain and make daily activities difficult.”

When contacted for comment, Cigna shared a statement originally provided to NBC News: “Lipedema is a painful condition that disproportionately impacts women, and we cover a range of treatment options, including liposuction, for patients that meet evidence-based clinical criteria. Ms. McCausland’s case was carefully reviewed by multiple doctors, including a plastic surgeon with expertise in lipedema. Based on the information submitted by her doctor, she did not meet the clinical criteria for liposuction at that time.”

McCausland, 30, says the disorder affects her lower legs and ankles. After trying other treatments without success, her doctor recommended liposuction — a procedure priced at $35,000. But she says her claim was denied twice.

She claims the rejection came down to one factor: “not feeling tenderness” in her affected joints. “I asked them, how can whoever is reviewing my appeal tell what the inside of my body feels like?” McCausland said in her video. “How can they look at my swollen ankles and be able to tell by looking that there is no tenderness?”

She also suspects that her appearance may have played a role in the denial. “You’re looking at me and thinking, ‘Diseased fat where?’ ” she said, referring to the fact that lipedema hasn’t affected her upper body, and she appears slim on social media.

Cigna responded to this, reiterating to PEOPLE the same statement they shared with NBC: “Our coverage decisions are based on the clinical information submitted by a patient’s treating physician in accordance with coverage policies and the patient’s plan design.”

McCausland told NBC News her condition also results in fatigue, brain fog, and difficulty with even simple activities like climbing stairs. “It’s definitely gotten much worse the older I’ve gotten,” she said. “Things that I feel like I should be able to do cause pain pretty quickly, and then I kind of have to tap out. Getting down to play with my kids is really hard.”

Her physician, Dr. David Smart, told NBC that surgery is often the only effective treatment to slow or reverse lipedema’s progression. “You can have a stage 1 patient that has very severe and crippling symptoms of pain and swelling,” he explained.

Dr. Smart criticized the insurance company’s decision-making process, saying, “They’re not looking at the severity of her symptoms. They’re not looking at the severity of her pain, the decrease in mobility, her lack of ability to be able to perform those daily activities of living.”

McCausland has since switched to a new insurance provider and is now working toward getting the surgery approved. Still, she expressed frustration about the broader healthcare system: “It’s ridiculous that we live in a country that, we have healthcare available to us, but it’s so inaccessible, that none of us can afford what we need.”