ABSTRACT
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Subject(s)
Abdominoplasty/economics , Diastasis, Muscle/surgery , Insurance Coverage/statistics & numerical data , Insurance, Health, Reimbursement/statistics & numerical data , Quality of Life , Rectus Abdominis/surgery , Abdominoplasty/methods , Adult , Diastasis, Muscle/diagnosis , Female , Humans , Insurance Claim Review , Insurance, Health, Reimbursement/economics , Male , Middle Aged , Prognosis , Rectus Abdominis/physiopathology , Risk Assessment , Societies, Medical , Surgery, Plastic , Treatment Outcome , United StatesABSTRACT
Background: Reduction mammoplasty has been shown to provide wide-ranging benefits for patients including improved quality of life in terms of physical function and mental health. However, most existing studies have been limited to the 1-year postoperative period. The aim of this study was to investigate long-term outcomes after reduction mammoplasty. Methods: Patients who underwent reduction mammoplasty at a single institution were identified retrospectively and grouped into 3 categories based on time since surgery: (i) 5 to 10 years, (ii) 10 to 15 years, and (iii) more than 15 years. A telephone survey was administered to measure satisfaction and symptom relief following reduction mammoplasty. Results: A total of 124 patients completed the survey and were included in the study. The majority of patients in all 3 groups reported marked symptoms relief (75% vs 82% vs 82%, P = .84). Overall satisfaction after reduction mammoplasty was high in all 3 subgroups and did not significantly decrease over time (4.16 vs 3.97 vs 3.7, P = .216) despite high proportions of patients reporting an increase in breast size since surgery (40% vs 70% vs 51%, P = .0297). Conclusions: Overall, reduction mammoplasty has long-lasting benefits for patients with macromastia. Overwhelmingly, patients report satisfaction with the procedure and marked symptom relief that is sustained for as long as 15 years after surgery.
