Continuing Insurance Coverage for Perforator Flap Breast Reconstruction: Is There a Reservation Cost Related to a Woman's Abdominal Flap Choice
Jose A. Foppiani*1, Erin Kim1, Allan Weidman1, Angelica Hernandez Alvarez1, Lauren Valentine1, Theodore Lee2, Bernard T. Lee1, Samuel Lin1
1Plastic Surgery, Beth Israel Deaconess Medical Center, Boston, MA; 2Roxbury Latin School, Boston, MA
Recent public discussion regarding medical billing has raised concerns about the potential loss of insurance coverage for deep inferior epigastric perforator (DIEP) flap breast reconstruction by December 2024. These changes may require patients to pay out-of-pocket for this procedure. This study seeks to identify factors influencing women's preferences for autologous breast reconstruction to assess the potential impact of such coverage changes.
A survey was conducted among adult women in the United States via the Amazon Mechanical Turk crowdsourcing platform. Questions assessed demographic information and gauged patient preferences for breast reconstructive options, ultimately asking participants to choose between descriptions of DIEP and transverse rectus abdominis myocutaneous (TRAM) flap surgery with incremental increases in out-of-pocket payments.
Of 500 total responses, 485 were completed and correctly answered a question to verify adequate attention to the survey questions. The median (IQR) age of respondents was 26 (25, 39) years old. When presented with the advantages and disadvantages of DIEP versus TRAM flaps, 78% of respondents preferred DIEP flap reconstruction. When presented with the same choice, however, with DIEP flaps being associated with an incrementally rising price, an increasing proportion of the respondents favored the cheaper TRAM option with $3,805 out of pocket being the "indifference point," where the proportions of patients selecting either procedure converged to become equivalent (p < 0.001). Interestingly, a personal history of breast reconstruction was significantly associated with a higher preference for DIEP, even with an associated out-of-pocket cost of $10,000 (p = 0.04).
Out-of-pocket cost can significantly influence women's choices for breast reconstruction. These findings encourage a reconsideration of newly proposed insurance practices that could potentially increase out-of-pocket costs associated with DIEP flaps, to prevent cost from decreasing equitable patient access to most current reconstructive options.
Fig. Regional Variations in the U.S.: Change in Proportion of Women Choosing DIEP Flap over TRAM Flap Breast Reconstruction with Incremental Increase in Cost.
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