The Medical Necessity for Treatment of Port‐Wine Stains

• Published in: Dermatologic surgery Vol. 23; no. 8; pp. 663 - 667
• Main Authors: McCLEAN, KELLY, HANKE, C. WILLIAM
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.1997; Blackwell
• Subjects: Age Factors; Biological and medical sciences; Dermatologic Surgical Procedures; Dermatology; Disease Progression; District of Columbia; Health Policy; Health Services Needs and Demand; Hereditary diseases of the skin. Congenital diseases of the skin. Haemangioma of the skin, of mucosae and of soft tissue; Humans; Infant; Insurance Coverage; Insurance, Health; Laser Coagulation; Medical sciences; Port-Wine Stain - complications; Port-Wine Stain - pathology; Port-Wine Stain - physiopathology; Port-Wine Stain - psychology; Port-Wine Stain - surgery; Practice Guidelines as Topic; Skin - pathology; Surgery, Plastic; Surveys and Questionnaires; United States; United States; North America; America; District of Columbia; Human; Skin disease; Survey; Treatment; Congenital disease; Angioma simplex
• ISSN: 1076-0512; 1524-4725
• DOI: 10.1111/j.1524-4725.1997.tb00386.x

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 arc 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.