Dowden R V, McCraw J B, Dibbell D G
JAMA. 1979 Dec 21;242(25):2779-82.
To determine policies of health insurance companies regarding payment for breast reconstruction following mastectomy, we polled 50 companies selected at random, as well as every Blue Cross-Blue Shield company. To verify that insurance carriers' replies represented their practices, we polled 96 plastic and reconstructive surgeons in 47 states. Although most health insurance carriers claim to fully cover breast reconstruction following mastectomy for cancer, practices vary widely; many postmastectomy patients receive incomplete or no coverage for reconstruction. Two major reasons for discrepancies appear to be (1) inadequate coverage prompted by unrealistic conception of reconstruction on the part of carriers and (2) specific contractual exclusion. We suggest (1) educating lay and professional persons about breast reconstruction, (2) encouraging more realistic coverage from insurance companies, and (3) if necessary, legislative protection for the postmastectomy patient.
为确定健康保险公司对于乳房切除术后乳房重建支付的政策，我们随机调查了50家公司以及每一家蓝十字蓝盾公司。为核实保险公司的回复代表了他们的实际做法，我们在47个州对96名整形和重建外科医生进行了调查。尽管大多数健康保险公司声称对因癌症进行乳房切除术后的乳房重建提供全额保险，但实际做法差异很大；许多乳房切除术后的患者在重建方面获得的保险不完全或根本没有保险。差异的两个主要原因似乎是：（1）保险公司对重建的不切实际观念导致保险范围不足；（2）具体的合同排除条款。我们建议：（1）对非专业人士和专业人士进行乳房重建方面的教育；（2）鼓励保险公司提供更实际的保险范围；（3）如有必要，为乳房切除术后的患者提供立法保护。
