Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, 21230, USA.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD, USA.
Aesthetic Plast Surg. 2019 Oct;43(5):1250-1256. doi: 10.1007/s00266-019-01420-7. Epub 2019 Jun 25.
Recent years have seen an increased utilisation of upper body lift following massive weight loss. Although it is typically considered cosmetic, the recurrent skin conditions and decline in quality of life may warrant medical necessity. We evaluated current insurance coverage and characterised policy criteria for upper body lift in the post-bariatric population.
We defined upper body lift as a combination of mastopexy and upper back excision (UBE) and conducted a cross-sectional analysis of US insurance policies. Insurance companies were selected based on their enrolment data and market share. A web-based search and telephone interviews were conducted to identify the policy. Criteria were abstracted from the publicly available policies that offered coverage.
Of the 56 insurance companies assessed, 5% would consider coverage of both procedures. Although fewer companies held established policies for UBE than mastopexy in the post-bariatric population (79% vs 96%, p = 0.0081), there were significantly more policies that offered pre-approval for UBE than for mastopexy (30% vs 5%, p = 0.0017). Three medical necessity criteria were common to both procedures: evidence of functional impairment, secondary skin conditions, and medical photographs.
Policy criteria for coverage of mastopexy or UBE differ greatly between companies. Further evaluation of medical necessity criteria for post-bariatric mastopexy and UBE with the establishment of a standardised guideline is needed. We propose a comprehensive list of reporting recommendations to help optimise authorisation of upper body lift in the post-bariatric population, and we urge plastic surgeons to challenge current definition of "cosmetic" by insurance companies.
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近年来，随着大量体重减轻，人们越来越多地使用上身提升术。尽管它通常被认为是美容的，但反复出现的皮肤状况和生活质量下降可能需要医学上的必要性。我们评估了当前的保险范围，并描述了后减重人群中上身提升术的政策标准。
我们将上身提升术定义为乳房提升术和上背部切除术（UBE）的组合，并对美国的保险政策进行了横断面分析。根据其入组数据和市场份额选择保险公司。通过网络搜索和电话访谈确定政策。从公开提供的涵盖保险范围内的政策中提取标准。
在所评估的 56 家保险公司中，有 5%的保险公司会考虑承保这两种手术。尽管在减重后人群中，提供 UBE 承保的公司比提供乳房提升术承保的公司少（79%比 96%，p=0.0081），但提供 UBE 预授权的政策比乳房提升术的政策多（30%比 5%，p=0.0017）。这两种手术都有三个常见的医学必要性标准：功能障碍的证据、继发性皮肤状况和医学照片。
承保乳房提升术或 UBE 的政策标准在不同公司之间差异很大。需要进一步评估减重后乳房提升术和 UBE 的医学必要性标准，并建立标准化指南。我们提出了一份全面的报告建议清单，以帮助优化减重后人群中上身提升术的授权，并敦促整形医生挑战保险公司目前对“美容”的定义。
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