Ha Michael, Finkelstein Emily R, Wieland Mark, Qadri Aasheen, Brown Madeline, Ejimogu Jason, Rasko Yvonne M
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine, Baltimore, USA.
Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, USA.
Cureus. 2022 Dec 31;14(12):e33184. doi: 10.7759/cureus.33184. eCollection 2022 Dec.
Introduction Dermabrasion and chemical peels are infrequently utilized methods of treatment for medical-grade conditions despite demonstrations of favorable outcomes. Insurance coverage status has previously been shown to impact availability and accessibility to specific treatments. The purpose of this study is to evaluate the rate of insurance coverage provided for dermabrasion and chemical peel procedures in the treatment of acne, acne scarring, and non-melanoma skin cancers (NMSC). Methods A cross-sectional analysis of 58 insurance companies by web-based search or phone interview determined the number of insurers with a publicly available policy on dermabrasion or chemical peels. Coverage status and any corresponding criteria were extracted from existing company policies. Results Thirteen (22%) and 22 (38%) policies discussed dermabrasion in the treatment of basal cell carcinoma and actinic keratosis, with 62% and 73% of these policies providing coverage. Acne scarring was discussed in significantly more dermabrasion policies than basal cell carcinoma (45% vs 22%; p=0.018). However, significantly more insurers denied coverage of dermabrasion for active acne and acne scarring when compared to dermabrasion to treat basal cell carcinoma or actinic keratosis (p<0.001). Eighty-seven percent of companies (n=20) with a chemical peel policy for premalignant lesions would provide coverage, with required criteria present in 95% (n=19) of the policies that would cover chemical peels for actinic keratosis specifically. Of the 25 companies (43%) that discussed the treatment of acne with chemical peel procedures, 14 (56%) provided coverage, and 11 (44%) denied coverage. Coverage was denied by significantly less insurers for the treatment of active acne with chemical peel procedures compared to treatment with dermabrasion (44% vs 83%; p<0.006). Conclusion Significant discrepancies were noted in both the presence of a public policy and the coverage status of dermabrasion or chemical peel procedures among the United States health insurance companies. These inconsistencies, along with multiple criteria required for coverage, may create an artificial barrier to receiving care for specific medical-grade conditions.
引言 尽管有证据表明磨皮术和化学剥脱术治疗医学级病症的效果良好，但它们仍是不常用的治疗方法。此前已有研究表明，保险覆盖情况会影响特定治疗的可获得性和可及性。本研究的目的是评估在治疗痤疮、痤疮瘢痕和非黑色素瘤皮肤癌（NMSC）时，磨皮术和化学剥脱术的保险覆盖率。方法 通过网络搜索或电话访谈对58家保险公司进行横断面分析，确定有公开磨皮术或化学剥脱术政策的保险公司数量。从现有公司政策中提取覆盖情况及任何相应标准。结果 有13项（22%）和22项（38%）政策讨论了磨皮术在基底细胞癌和光化性角化病治疗中的应用，其中62%和73%的此类政策提供保险覆盖。讨论痤疮瘢痕的磨皮术政策显著多于基底细胞癌（45%对22%；p = 0.018）。然而，与用于治疗基底细胞癌或光化性角化病的磨皮术相比，显著更多的保险公司拒绝为活动性痤疮和痤疮瘢痕的磨皮术提供保险覆盖（p < 0.001）。有针对癌前病变化学剥脱术政策的公司中，87%（n = 20）会提供保险覆盖，在专门针对光化性角化病化学剥脱术提供保险覆盖的政策中，95%（n = 19）有相关要求标准。在讨论用化学剥脱术治疗痤疮的25家公司（43%）中，14家（56%）提供保险覆盖，11家（44%）拒绝提供。与磨皮术治疗相比，保险公司拒绝为化学剥脱术治疗活动性痤疮提供保险覆盖的比例显著更低（44%对83%；p < 0.006）。结论 在美国健康保险公司中，磨皮术或化学剥脱术的公开政策存在情况以及保险覆盖情况存在显著差异。这些不一致之处，连同保险覆盖所需的多项标准，可能会为特定医学级病症的治疗设置人为障碍。
