Trends in insurance coverage for adolescent reduction mammaplasty

Area of Science:

• Plastic Surgery
• Health Services Research
• Health Economics

Background:

• Reduction mammaplasty effectively treats symptomatic macromastia.
• Existing research indicates inconsistent insurance policy criteria for adult patients.
• This study investigates insurance preauthorization trends for adolescent reduction mammaplasty.

Purpose of the Study:

• To analyze trends in insurance preauthorization for reduction mammaplasty in adolescents.
• To identify factors associated with preauthorization approval or denial.
• To assess the impact of insurance criteria on access to care for young patients.

Main Methods:

• Retrospective cohort study of patients aged 18 years or younger.
• Analysis of 249 preauthorization requests from 2010-2020.
• Evaluation of demographic data, clinical variables, insurance company, and preauthorization criteria.

Main Results:

• The overall approval rate was 79.5%, with a significant increase in submissions over the decade.
• Factors associated with denial included pre-2015 submissions, lower median zip code income, and predicted resection mass below the Schnur Sliding Scale threshold.
• Insurance company was also a significant factor in preauthorization outcomes.

Conclusions:

• Insurance preauthorization criteria for adolescent reduction mammaplasty are inconsistent and differ from adult guidelines.
• Current criteria may not be evidence-based and could create barriers to care, particularly for socioeconomically disadvantaged populations.
• Further research is needed to ensure equitable access to medically necessary procedures for adolescents.