Surgical Management of Diastasis Recti: A Systematic Review of Insurance Coverage in the United States
| Autor: | Ledibabari M. Ngaage, Carly Rosen, Sheri Slezak, Stephen M. Kavic, Erin M. Rada, Yvonne M. Rasko |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Diastasis Muscle medicine.medical_treatment Insurance Claim Review MEDLINE Rectus Abdominis 030230 surgery Risk Assessment Insurance Coverage 03 medical and health sciences 0302 clinical medicine Quality of life medicine Humans Elective surgery Surgery Plastic Diastasis recti Societies Medical Abdominoplasty business.industry General surgery Middle Aged medicine.disease Prognosis United States Treatment Outcome 030220 oncology & carcinogenesis Insurance Health Reimbursement Diastasis Quality of Life Surgery Female business Insurance coverage |
| Zdroj: | Annals of plastic surgery. 83(4) |
| ISSN: | 1536-3708 |
| Popis: | As elective surgery becomes more popular, the stringency of insurance coverage policies has increased exponentially. Many patients with diastasis recti (DR) are denied coverage of the corrective surgery that has been shown to improve function and quality of life in this patient population. Plastic surgeons are frustrated by the lack of guidelines and sparsity of coverage for surgical correction of DR.Fifty-four US insurance companies and Medicare were reviewed to determine their policies of coverage. These policies were compared with the guidelines set forth by the American Society of Plastic surgery and current literature on DR.Insurance company policy for DR repair is not clear nor well established. Of the 55 policies reviewed in this study, 51 had an established policy. Forty of these companies would not cover abdominoplasty to repair DR under any circumstances. Eleven companies required preauthorization to ensure that the patient met the requirements of medical necessity. These requirements differed from company to company. A comprehensive list was compiled of details required for preauthorization.Insurance company policies do not recognize the spectrum of patients with DR and the necessity of abdominoplasty to relieve symptoms of patients with severe debilitation. The current Common Procedural Terminology coding classifies abdominoplasty to repair DR solely as a cosmetic procedure. Policies for DR repair should be amended to include a functional procedure reimbursement for severe DR and include detailed guidelines for coverage requirements to simplify the reimbursement process. |
| Databáze: | OpenAIRE |
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