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Insurance Coverage for Massive Weight Loss Panniculectomy: A National Survey and Implications for Policy
Stephanie E. Dreifuss, MD and J. Peter Rubin, MD
University of Pittsburgh Medical Center
2015-03-12
Presenter: Stephanie E. Dreifuss, MD
Affidavit:
I attest that the abstract submitted by this resident represents her own original work
Director Name: Joseph E. Losee, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
PURPOSE
Currently, panniculectomy coverage guidelines are developed by insurance companies, while surgeons have limited input as to what policies are fair to doctors and patients. Here, for the first time, we have surveyed plastic surgeons nationally to determine their opinions on which criteria are clear, reasonable, and accessible.
METHODS
Panniculectomy coverage criteria were compiled for third party payers making up the largest market share. A survey using these criteria was distributed to all members of the American Society of Plastic Surgeons assessing three characteristics of each criterion – clarity, accessibility and reasonability. Scores were used to determine a rank for each criterion.
RESULTS
Criteria were collected from 63 insurance policies and were condensed into 17 summary criteria. The most common requirement was: "Chronic maceration of skin folds with failure to respond to at least three months of treatment with oral or topical medication." This was necessary for coverage by 81.0% of providers. However, based on survey data, this criterion ranked 12th out of 17. The least common were: "Stable weight loss with BMI<35" and "The pannus . . . covers the genitals and upper thigh crease." These were each required by only one insurance policy but were assigned ranks of 6th and 7th respectively.
CONCLUSIONS
Here, we present a physician assessment of insurance criteria for the coverage of panniculectomy. Given the discrepancy between how frequently a criterion is required for coverage and how favorably it is assessed by surgeons, we conclude that more physician involvement in guideline development may be beneficial.
