Review of Insurance Coverage for Abdominal Contouring Procedures in the Postbariatric Population.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
entrez:
28
1
2020
pubmed:
28
1
2020
medline:
6
2
2020
Statut:
ppublish
Résumé
Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population. The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage. Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415). For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.
Sections du résumé
BACKGROUND
BACKGROUND
Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population.
METHODS
METHODS
The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage.
RESULTS
RESULTS
Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415).
CONCLUSIONS
CONCLUSIONS
For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.
Identifiants
pubmed: 31985657
doi: 10.1097/PRS.0000000000006513
pii: 00006534-202002000-00052
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
545-554Références
Kitzinger HB, Abayev S, Pittermann A, et al. The prevalence of body contouring surgery after gastric bypass surgery. Obes Surg. 2012;22:8–12.
American Society of Plastic Surgeons. Practice parameter for surgical treatment of skin redundancy for obese and massive weight loss patients. Available at: https://www.plasticsurgery.org/documents/Health-Policy/Guidelines/guideline-2017-skin-redundancy.pdf. Accessed January 14, 2019.
Mitchell JE, Crosby RD, Ertelt TW, et al. The desire for body contouring surgery after bariatric surgery. Obes Surg. 2008;18:1308–1312.
Steffen KJ, Sarwer DB, Thompson JK, Mueller A, Baker AW, Mitchell JE. Predictors of satisfaction with excess skin and desire for body contouring after bariatric surgery. Surg Obes Relat Dis. 2012;8:92–97.
Migliori F, Rosati C, D’Alessandro G, Cervetti GG. Body contouring after biliopancreatic diversion. Obes Surg. 2006;16:1638–1644.
American Society of Plastic Surgeons. ASPS recommended insurance coverage criteria for third-party payers: Surgical treatment of skin redundancy for obese and massive weight loss patients. Available at: https://www.plasticsurgery.org/Documents/Health-Policy/Reimbursement/insurance-2017-skin-redundancy-for-obese-and-massive-weight-loss-patients.pdf. Accessed March 20, 2019.
Rosen CM, Ngaage LM, Rada EM, Slezak S, Kavic S, Rasko Y. Surgical management of diastasis recti: A systematic review of insurance coverage in the United States. Ann Plast Surg. 2019;83:475–480.
Singer S, Berghold L, Vorhaus C, et al. Decreasing variation in medical necessity decision making: Final report to the California HealthCare Foundation. Available at: https://www.chcf.org/wp-content/uploads/2017/12/PDF-medicalnec.pdf. Accessed January 24, 2019.
Dreifuss SE, Rubin JP. Insurance coverage for massive weight loss panniculectomy: A national survey and implications for policy. Surg Obes Relat Dis. 2016;12:412–416.
Sati S, Pandya S. Should a panniculectomy/abdominoplasty after massive weight loss be covered by insurance? Ann Plast Surg. 2008;60:502–504.
Gurunluoglu R. Panniculectomy and redundant skin surgery in massive weight loss patients: Current guidelines and recommendations for medical necessity determination. Ann Plast Surg. 2008;61:654–657.
Gurunluoglu R. Insurance coverage criteria for panniculectomy and redundant skin surgery after bariatric surgery: Why and when to discuss. Obes Surg. 2009;19:517–520.
Henry J. Kaiser Foundation. Market share and enrollment of largest three insurers: Individual market. Available at: https://www.kff.org/private-insurance/state-indicator/market-share-and-enrollment-of-largest-three-insurers-individual-market/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed January 31, 2019.
National Association of Insurance Commissioners. 2017 market share reports for the top 125 accident and health insurance groups and companies by state and countrywide. Available at: https://www.naic.org/prod_serv/MSR-HB-18.pdf. Accessed January 31, 2019.
Aherrera AS, Pandya SN. A cohort analysis of postbariatric panniculectomy: Current trends in surgeon reimbursement. Ann Plast Surg. 2016;76:99–101.
Biörserud C, Olbers T, Fagevik Olsén M. Patients’ experience of surplus skin after laparoscopic gastric bypass. Obes Surg. 2011;21:273–277.
Biörserud C, Olbers T, Søvik TT, Mala T, Elander A, Olsén MF. Experience of excess skin after gastric bypass or duodenal switch in patients with super obesity. Surg Obes Relat Dis. 2014;10:891–896.
Coriddi MR, Koltz PF, Chen R, Gusenoff JA. Changes in quality of life and functional status following abdominal contouring in the massive weight loss population. Plast Reconstr Surg. 2011;128:520–526.
Toma T, Harling L, Athanasiou T, Darzi A, Ashrafian H. Does body contouring after bariatric weight loss enhance quality of life? A systematic review of QOL studies. Obes Surg. 2018;28:3333–3341.
Modarress A, Balagué N, Huber O, Chilcott M, Pittet-Cuénod B. Plastic surgery after gastric bypass improves long-term quality of life. Obes Surg. 2013;23:24–30.
Coon D, Gusenoff JA, Kannan N, El Khoudary SR, Naghshineh N, Rubin JP. Body mass and surgical complications in the postbariatric reconstructive patient: Analysis of 511 cases. Ann Surg. 2009;249:397–401.
Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for body contour surgery. Clin Plast Surg. 2004;31:601–610, vi.
Momeni A, Heier M, Bannasch H, Stark GB. Complications in abdominoplasty: A risk factor analysis. J Plast Reconstr Aesthet Surg. 2009;62:1250–1254.
Soldin M, Mughal M, Al-Hadithy N; Department of Health; British Association of Plastic, Reconstructive and Aesthetic Surgeons; Royal College of Surgeons England. National commissioning guidelines: Body contouring surgery after massive weight loss. J Plast Reconstr Aesthet Surg. 2014;67:1076–1081.
van der Beek ES, van der Molen AM, van Ramshorst B. Complications after body contouring surgery in post-bariatric patients: The importance of a stable weight close to normal. Obes Facts 2011;4:61–66.
Bossert RP, Rubin JP. Evaluation of the weight loss patient presenting for plastic surgery consultation. Plast Reconstr Surg. 2012;130:1361–1369.
O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: A randomized trial. Ann Intern Med. 2006;144:625–633.
Mendes FH, Viterbo F. Defining “weight stability” for post-bariatric body contouring procedures. Aesthetic Plast Surg. 2017;41:979–980.
Froylich D, Corcelles R, Daigle CR, et al. Weight loss is higher among patients who undergo body contouring procedures after bariatric surgery. Surg Obes Relat Dis. 2016;12:1731–1736.