A Cross-Sectional Analysis of American Insurance Coverage of Upper and Lower Lid Blepharoplasty.

Beita Badiei,Kevin Schlidt,Michael Ha,Caroline Simon,Chinenye Onyima,Jessica El-Mallah,Vivekka Nagendran,Yvonne M Rasko
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Abstract

OBJECTIVE Dermatochalasis is a common condition that can cause obstruction of peripheral visual fields and impairment of daily activities. These effects can be addressed with a blepharoplasty, which may be considered a cosmetic procedure by American health insurers. The authors assessed insurance coverage of all indications of blepharoplasty and their medical necessity criteria. METHODS A cross-sectional analysis was conducted of 70 insurance policies for blepharoplasty. The insurance companies were selected based on their state enrollment and market share. A web-based search and telephone interviews were utilized to identify the policies. Medically necessary criteria were extracted from the publicly available policies. RESULTS Of the 70 insurance policies assessed, 67 (96%) provide coverage for blepharoplasty. There were 7 indications for coverage, the most common being dermatochalasis causing functional visual impairment (n = 56, 80%), prosthesis difficulties in an anophthalmic socket (n = 44, 63%), and congenital ptosis (n = 38, 54%). Of companies that indicated coverage for dermatochalasis, 95% required visual field loss testing to qualify for coverage. Significantly more companies required a 30% loss in the superior visual field for coverage versus the literature-recommended amount of 24% loss (n = 14 versus n = 3, 26% versus 6%, P= 0.0067). CONCLUSION There is a great discrepancy in insurance policy criteria for coverage of blepharoplasty, especially regarding requirements for visual field testing. Unfortunately, this disparity does not reflect the current literature as to whom may gain significant functional benefit from blepharoplasty.
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上下眼睑整形手术美国保险覆盖范围的横断面分析。
目的 皮肤皲裂是一种常见疾病,可导致周边视野受阻,影响日常活动。这些影响可以通过眼睑成形术来解决,美国医疗保险公司可能会将其视为一种美容手术。作者评估了眼睑成形术所有适应症的保险范围及其医疗必要性标准。方法对 70 份眼睑成形术保险单进行了横截面分析。根据各州的投保情况和市场份额选择保险公司。通过网络搜索和电话采访确定了这些保单。结果 在评估的 70 份保险单中,67 份(96%)提供眼睑成形术保险。承保的适应症有 7 种,最常见的适应症是导致功能性视力障碍的真皮皲裂(56 例,80%)、在无眼眦处安装假体困难(44 例,63%)和先天性上睑下垂(38 例,54%)。在表示承保真皮皲裂症的公司中,95%的公司要求进行视野缺损测试才符合承保条件。有更多的公司要求承保范围内的上视野损失达到 30%,而文献建议的损失为 24%(n = 14 对 n = 3,26% 对 6%,P= 0.0067)。不幸的是,这种差异并没有反映出目前的文献资料表明谁可以从眼睑成形术中获得显著的功能性益处。
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