alexa The medical necessity for treatment of port-wine stains.
Dermatology

Dermatology

Cosmetology & Oro Facial Surgery

Author(s): McClean K, Hanke CW

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Abstract BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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". RESULTS: Insurance coverage for laser treatment of port-wine stains varies from state to state. CONCLUSION: 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.
This article was published in Dermatol Surg and referenced in Cosmetology & Oro Facial Surgery

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