The Medical Necessity for Treatment of Port-Wine Stains

Department of Dermatology, Indiana University School of Medicine, Indianapolis 46202, USA.
Dermatologic Surgery (Impact Factor: 2.11). 09/1997; 23(8):663-7. DOI: 10.1111/j.1524-4725.1997.tb00386.x
Source: PubMed


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.

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    ABSTRACT: The 585 nm flashlamp-pumped pulsed (FLPP) dye laser is an effective and established treatment for port-wine stains (PWSs) during childhood. Unfortunately, PWSs tend to darken in color and may thicken or develop nodules as the lesions age, thereby making treatment difficult in adult patients since they may require several laser sessions producing unpredictable results. The aim of this article is to present and discuss the results obtained in four adult patients with PWS by use of a new approach in FLPP dye laser treatment. The goal of this technique was to damage, during the same treatment, the lesions at both deep and superficial levels and to reduce the number of laser sessions required to obtain the most effective eradication of hypertrophied PWSs. Four patients (two men and two women aged 54, 57, 49, and 61, respectively) were referred for treatment of congenital hypertrophied PWS of the face. Every dye laser session consisted of two laser passes. During the first pass the wavelength ranged from 590 to 600 nm with a long pulse (1.500 microseconds), while the second pass was performed utilizing the classic short pulse (450 microseconds) and wavelength (585 nm). Successive treatments were performed at 6- to 8-week intervals. All four patients had a complete clearing of their PWS after a number of treatments, ranging from three to five sessions. Three of them (one man and the two women) experienced extremely mild blistering in a limited small area that healed in approximately 10 days without scarring. The laser sessions were well tolerated by all patients. None of the patients developed atrophic or hypertrophied scars or dyschromia. Our results show an excellent response in all patients with just a few treatments (three to five sessions) and, in spite of two passes, only mild side effects that are probably limited due to cooling of the skin. We also observed a flattening and reduction of the nodules.
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