TY - JOUR
T1 - A review of American insurance coverage and criteria for conservative management of lymphedema
AU - Finkelstein, Emily R.
AU - Ha, Michael
AU - Hanwright, Philip
AU - Ngaage, Ledibabari M.
AU - Yoon, Joshua S.
AU - Liang, Fan
AU - Nam, Arthur J.
AU - Rasko, Yvonne M.
N1 - Funding Information:
The editors and reviewers of this article have no relevant financial relationships to disclose per the Journal policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.
Publisher Copyright:
© 2022
PY - 2022/7
Y1 - 2022/7
N2 - Objective: Lymphedema affects >1 in 1000 Americans, most often resulting from breast cancer surgery. Conservative treatment, such as compression garments, combined decongestive therapy (CDT), and pneumatic compression pumps, is the current standard of care. Despite the wide availability of these therapies, lymphedema has remained undertreated worldwide. We investigated whether third-party insurance coverage might be a barrier to obtaining conservative treatment in the United States. Methods: We conducted a cross-sectional analysis of publicly accessible insurance policies. A total of 58 insurers were included in accordance with their state enrollment data and market share. The analysis was conducted using a web-based search and individual telephone interviews. For those policies that extended coverage, the medical necessity criteria were abstracted. Results: A total of 50 insurance companies (86%) had a policy in place addressing conservative management. Included in 37 policies (64%), compression garments were covered the least often (n = 33; 89%). Although CDT was included in only 22 policies (38%), it was universally covered. Noncalibrated pneumatic compression pumps were the most frequently addressed intervention (n = 46; 79%), significantly more often than CDT (P < .01) and were universally covered, significantly more often than were compression garments (P < .04). Criteria for reimbursement were present for more than one half of the policies that provided coverage. Conclusions: A large proportion of U.S. insurers provided coverage for conservative treatment of lymphedema. However, only 38% of the policies included a statement of coverage for CDT. Most of the policies that did provide coverage for these four therapies also had multiple criteria that were required to be met before considering reimbursement. These requirements could create barriers to the receipt of treatment.
AB - Objective: Lymphedema affects >1 in 1000 Americans, most often resulting from breast cancer surgery. Conservative treatment, such as compression garments, combined decongestive therapy (CDT), and pneumatic compression pumps, is the current standard of care. Despite the wide availability of these therapies, lymphedema has remained undertreated worldwide. We investigated whether third-party insurance coverage might be a barrier to obtaining conservative treatment in the United States. Methods: We conducted a cross-sectional analysis of publicly accessible insurance policies. A total of 58 insurers were included in accordance with their state enrollment data and market share. The analysis was conducted using a web-based search and individual telephone interviews. For those policies that extended coverage, the medical necessity criteria were abstracted. Results: A total of 50 insurance companies (86%) had a policy in place addressing conservative management. Included in 37 policies (64%), compression garments were covered the least often (n = 33; 89%). Although CDT was included in only 22 policies (38%), it was universally covered. Noncalibrated pneumatic compression pumps were the most frequently addressed intervention (n = 46; 79%), significantly more often than CDT (P < .01) and were universally covered, significantly more often than were compression garments (P < .04). Criteria for reimbursement were present for more than one half of the policies that provided coverage. Conclusions: A large proportion of U.S. insurers provided coverage for conservative treatment of lymphedema. However, only 38% of the policies included a statement of coverage for CDT. Most of the policies that did provide coverage for these four therapies also had multiple criteria that were required to be met before considering reimbursement. These requirements could create barriers to the receipt of treatment.
KW - CDT
KW - Compression
KW - Conservative treatment
KW - Insurance coverage
KW - Lymphedema
KW - Pneumatic compression pump
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U2 - 10.1016/j.jvsv.2022.03.008
DO - 10.1016/j.jvsv.2022.03.008
M3 - Article
C2 - 35364303
AN - SCOPUS:85132455135
SN - 2213-333X
VL - 10
SP - 929
EP - 936
JO - Journal of Vascular Surgery: Venous and Lymphatic Disorders
JF - Journal of Vascular Surgery: Venous and Lymphatic Disorders
IS - 4
ER -