Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Division of Reconstructive and Plastic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
Am J Surg. 2022 Oct;224(4):1068-1073. doi: 10.1016/j.amjsurg.2022.07.030. Epub 2022 Aug 5.
Reduction mammaplasty is an effective intervention for symptomatic macromastia. Studies of insurance policy criteria for adult patients have demonstrated nonuniformity. This study assesses trends in insurance preauthorization for reduction mammaplasty in the adolescent population.
A retrospective cohort study of patients aged ≤18 years at a pediatric breast clinic between January 1, 2010 and December 31, 2020. Demographic information and clinical variables submitted to insurers were analyzed, as well as third-party payer company, provider network type, and preauthorization criteria.
249 preauthorization requests were studied, with an approval rate of 79.5%. Submissions increased from 6 in 2010 to 59 in 2020. Variables deemed significantly associated with preauthorization denial included submission before 2015 (OR 2.04, 95% CI 1.04-3.95, p = .038), billing zip code median income <$60,000 (OR 2.11, 95% CI 1.12-3.98 p = .02), predicted resection mass below Schnur Sliding Scale threshold (OR 1.97, 95% CI 1.01-3.83 p = .047), and insurance company.
Insurance criteria for preauthorization of reduction mammaplasty in adolescents differ from adults, are not supported by clinical studies, and may exclude low-income patients from receiving care.
缩乳术是治疗巨乳症的有效方法。对成人患者的保险政策标准进行的研究表明，这些标准并不统一。本研究评估了青少年人群缩乳术保险预授权的趋势。
对 2010 年 1 月 1 日至 2020 年 12 月 31 日期间在儿科乳房诊所就诊的≤18 岁患者进行回顾性队列研究。分析了提交给保险公司的人口统计学信息和临床变量，以及第三方支付公司、提供者网络类型和预授权标准。
研究了 249 份预授权请求，批准率为 79.5%。提交的数量从 2010 年的 6 份增加到 2020 年的 59 份。被认为与预授权拒绝显著相关的变量包括 2015 年之前提交（OR 2.04，95%CI 1.04-3.95，p=0.038）、计费邮政编码中位数收入<60,000 美元（OR 2.11，95%CI 1.12-3.98，p=0.02）、预测切除质量低于 Schnur 滑动量表阈值（OR 1.97，95%CI 1.01-3.83，p=0.047）和保险公司。
青少年缩乳术保险预授权的标准与成人不同，没有临床研究支持，并且可能使低收入患者无法获得治疗。
