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United States insurance coverage of immediate lymphatic reconstruction.
La-Anyane, Okensama; Alba, Brandon E; Harmon, Kelly A; To, Jocelyn; Siotos, Charalampos; Adepoju, Jubril; Madrigrano, Andrea; Alvarado, Rosalinda; O'Donoghue, Cristina; Perez, Claudia B; Kurlander, David E; Shenaq, Deana S; Kokosis, George.
Afiliación
  • La-Anyane O; Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
  • Alba BE; Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
  • Harmon KA; Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
  • To J; Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA.
  • Siotos C; Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
  • Adepoju J; Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
  • Madrigrano A; Division of Surgical Oncology, Rush University Medical Center, Chicago, IL, USA.
  • Alvarado R; Division of Surgical Oncology, Rush University Medical Center, Chicago, IL, USA.
  • O'Donoghue C; Division of Surgical Oncology, Rush University Medical Center, Chicago, IL, USA.
  • Perez CB; Division of Surgical Oncology, Rush University Medical Center, Chicago, IL, USA.
  • Kurlander DE; Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
  • Shenaq DS; Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
  • Kokosis G; Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
J Surg Oncol ; 129(3): 584-591, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38018351
INTRODUCTION: Immediate Lymphatic Reconstruction (ILR) is a prophylactic microsurgical lymphovenous bypass technique developed to prevent breast cancer related lymphedema (BCRL). We investigated current coverage policies for ILR among the top insurance providers in the United States and compared it to our institutional experience with obtaining coverage for ILR. METHODS: The study analyzed the publicly available ILR coverage statements for American insurers with the largest market share and enrollment per state to assess coverage status. Institutional ILR coverage was retrospectively analyzed using deidentified claims data and categorizing denials based on payer reason codes. RESULTS: Of the 63 insurance companies queried, 42.9% did not have any publicly available policies regarding ILR coverage. Of the companies with a public policy, 75.0% deny coverage for ILR. In our institutional experience, $170,071.80 was charged for ILR and $166 118.99 (97.7%) was denied by insurance. CONCLUSIONS: Over half of America's major insurance providers currently deny coverage for ILR, which is consistent with our institutional experience. Randomized trials to evaluate the efficacy of ILR are underway and focus should be shifted towards sharing high level evidence to increase insurance coverage for BCRL prevention.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos de Cirugía Plástica / Linfedema del Cáncer de Mama Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Surg Oncol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos de Cirugía Plástica / Linfedema del Cáncer de Mama Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Surg Oncol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos