Highlights
- •Adolescent reduction mammaplasty are increasing components of pediatric plastic surgery practice.
- •Insurance preauthorization for reduction have increased over the past decade, and age cutoffs are becoming less frequent.
- •Insurance company and family income under $60K per year were independent predictors of preauthorization denial.
- •Criteria most cited for denials were lack of prior conservative management, age <18 y/o, and unmet minimum resection weight.
Abstract
Background
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.
Methods
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.
Results
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 <$60,000 (OR 2.11, 95% CI 1.12–3.98 p = .02),
predicted resection mass below Schnur Sliding Scale threshold (OR 1.97, 95% CI 1.01–3.83
p = .047), and insurance company.
Conclusions
Insurance criteria for preauthorization of reduction mammaplasty in adolescents differ
from adults, are not supported by clinical studies, and may exclude low-income patients
from receiving care.
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Article info
Publication history
Published online: August 04, 2022
Accepted:
July 31,
2022
Received in revised form:
July 4,
2022
Received:
May 25,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
