The medical necessity for treatment of port-wine stains.
ABSTRACT Port-wine stains are congenital vascular malformations that can be disfiguring and may lead to psychosocial as well as medical complications. The 585-nm pulsed dye laser is very effective in treating port-wine stains. Laser treatment is often viewed by insurance companies as a "cosmetic procedure" and not "medically necessary". Consequently many patients are denied coverage for treatment of their disfiguring birthmarks.
To determine variability of insurance coverage for laser treatment of port-wine stains from state to state. Natural history, progression, and potential complications of port-wine stains are reviewed and rationale for consistent insurance coverage for laser treatment of port-wine stains is given.
A questionnaire was mailed to 40 dermatologic surgeons in 22 states and the District of Columbia. We reviewed the literature regarding port-wine stains and their potential complications, and health care policy guidelines regarding "medical necessity" and "cosmetic procedures".
Insurance coverage for laser treatment of port-wine stains varies from state to state.
Based on current health care policy guidelines, laser treatment of port-wine stains should be regarded, and covered, as a medical necessity by all insurance providers.
SourceAvailable from: Robert M Bernstein[Show abstract] [Hide abstract]
ABSTRACT: An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein. Dermatologists have been responsible for multiple advances and refinements in dermatologic office-based surgery over many decades. Dermatologists receive extensive training in office-based surgical procedures during residency, fellowships, and continuing medical education courses. The last update on this subject appeared in the Journal in 1999. This article will document the multitude of advances that have occurred since 1999.Journal of the American Academy of Dermatology 10/2013; 69(6). DOI:10.1016/j.jaad.2013.04.067 · 5.00 Impact Factor
Article: Dermatologic laser surgerySeminars in Cutaneous Medicine and Surgery 01/2001; 13(1):5–24. DOI:10.1016/S1040-0486(01)70027-0 · 2.40 Impact Factor