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A Review of Private Insurance Policies: Coverage of Fat Grafting for Breast and Head & Neck Reconstruction
Yusuf Surucu, MD; Bahaa Shaaban, MD; Pooja Humar, BS; Elizabeth A. Moroni, MD MHA; Rakan Saadoun, MD; M. Saad Hafeez, MD; Yadira Villalvazo, MD; Jeffrey H. Kozlow, MD; J. Peter Rubin, MD
University of Pittsburgh
2023-02-10
Presenter: Yusuf Surucu
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: J. Peter Rubin, MD, MBA
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
PURPOSE:
The Women's Health and Cancer Rights Act of 1998 codified access to reconstructive surgery for breast cancer patients. Correspondingly,fat grafting, when used for oncologic breast reconstruction, is routinely covered by insurance providers. However, we suspect that fat graftingapplications for other reconstructive goals, particularly to the face, are not as widely covered or reimbursed.
METHODS:
Policies of private medical insurance companies were examined for information regarding coverage or reimbursement of fat graftingafter breast or head and neck reconstruction. Keywords including "fat grafting," "lipofilling," "reconstructive surgery," "cosmetic surgery," "breastreconstruction," and "facial reconstruction" were used on each company's website.
RESULTS:
The 25 largest private insurance companies based on collected premiums were included in this study. Eight companies deemed fatgrafting for breast reconstruction to be medically necessary, 12 regarded it to be experimental, 1 considered it to be cosmetic, and 1 left thedecision to the surgeon's discretion. For facial reconstruction, only 3 companies report fat grafting as medically necessary, 11 deem it asexperimental, 5 consider it cosmetic, and 3 rely on the discretion of the surgeon. Eleven companies report covering fat grafting for breastreconstruction, while only 5 private companies include coverage for facial fat grafting.
CONCLUSION:
While fat grafting is widely used to reconstruct the breast and face, there is significant variability in private insurance coverage forthis procedure. Moving forward, we aim to compare policies from commercial insurance companies with state-level Medicare and Medicaidguidelines regarding fat grafting.
