Trends in insurance coverage for adolescent reduction mammaplasty

• Published in: The American journal of surgery 2022-10, Vol.224 (4), p.1068-1073
• Main Authors: Kimia, Rotem, Magee, Leanne, Caplan, Howard S., Low, David W., Jackson, Oksana A., Butler, Paris D.
• Format: Article
• Language: English
• Subjects: Adolescents; Age; Body image; Body mass index; Breast cancer; Breasts; Child development; Criteria; Demographic variables; Electronic health records; Ethnicity; Income; Insurance; Insurance companies; Insurance coverage; Mental health; Patients; Pediatrics; Plastic surgery; Self image; Teenagers; Trends
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2022.07.030

Reduction mammaplasty is an effective intervention for symptomatic macromastia. Studies of insurance policy criteria for adult patients have demonstrated nonuniformity. This study assesses trends in insurance preauthorization for reduction mammaplasty in the adolescent population. A retrospective cohort study of patients aged ≤18 years at a pediatric breast clinic between January 1, 2010 and December 31, 2020. Demographic information and clinical variables submitted to insurers were analyzed, as well as third-party payer company, provider network type, and preauthorization criteria. 249 preauthorization requests were studied, with an approval rate of 79.5%. Submissions increased from 6 in 2010 to 59 in 2020. Variables deemed significantly associated with preauthorization denial included submission before 2015 (OR 2.04, 95% CI 1.04–3.95, p = .038), billing zip code median income