Should Physical Therapy Be an Insurance Requirement for Patients Seeking a Breast Reduction?
Year: 2023
Type: article
Abstract: Insurance authorization is a frequent challenge for patients experiencing symptoms such as chronic neck, shoulder, and back pain, as well as erythema intertrigo related to macromastia, who are seeking a reduction mammaplasty. Every insurance company has numerous requirements that must be met prior to providing authorization for such surgeries. Some of these requirements include use of supportive bras, use of topical treatments for erythema intertrigo, as well as use of pain medications and physical therapy for specific time periods prior to insurance authorization, which restrict patients from undergoing surgery for this condition.1 Additionally, required documentation for coverage of the procedure involves reporting the expected removal of a minimum weight in grams of tissue.1 Yet, despite these patients undertaking these conservative measures without improvement, and strong evidence of improvement in not only physical well-being but also psychosocial and sexual well-being with surgery, insurance companies continue to deny surgery.1,2 More recently, some insurance companies have even increased the expected removal of a minimum weight in grams of tissue based on the body surface area. Additionally, there has been little focus in the plastic surgery literature on the efficacy of physical therapy in patients with macromastia prior to surgery. Physical therapy is currently mandated by insurance companies and poses a significant barrier to patients progressing from conservative treatment to a reduction mammaplasty due to extended treatment times and sizable expense.3 The efficacy of physical therapy in significantly reducing symptoms related to macromastia remains to be adequately supported in the plastic surgery literature. In fact, limited studies on the topic suggest it likely fails to permanently improve symptoms. Collins et al, in a study of 179 women with macromastia who underwent physical therapy, found that only a small proportion of patients experienced temporary relief of their symptoms.4 Only 5% of these patients had permanent relief of their symptoms, while 90% of patients who underwent reduction mammaplasty had permanent relief.4 This is likely due to the fact that physical therapy does not address the underlying condition. Additionally, if physical therapy notes do not accurately document that symptoms are related to macromastia, the patient is often required to repeat this long and expensive course of treatment. These conservative treatments lead to excessively long delays in care. Patients with macromastia commonly will go up to 11 years prior to obtaining a breast reduction procedure.3 Not only do these patients wait for extended time periods, but the cost to them is exorbitant.3 In Europe these patients were found to pay between €1677.55 and €9450.54 per year prior to receiving a reduction mammaplasty.3 This puts an undue financial burden on these women when a reduction mammaplasty is €3437.74 in comparison.3,5 Patients suffering from macromastia experience an undue barrier to their care due to excessive insurance requirements, which can in turn lead to economic health inequality and prolongation of symptoms. Future research should focus on the effect and impact physical therapy has on patients seeking a reduction mammaplasty to better understand the necessity of this insurance requirement. The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. The authors received no financial support for the research, authorship, and publication of this article.
Source: Aesthetic Surgery Journal
DOI: 10.1093/asj/sjad120
Institution: University of Colorado Anschutz
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4366998756