Nationwide Evaluation of Cost and Insurance coverage for Reduction Mammoplasty in Outpatient setting
Nargiz Seyidova*, Olachi O. Oleru, Sarah Nathaniel, Nikita Roy, Martina Brozynski, Lior Levy, Anais Di Via Ioschpe, Daniel Y. Kwon, Peter J. Taub
Plastic Surgery, Mount Sinai Hospital, New York, NY
Despite proven benefits of reduction mammoplasty, the procedure is often denied by insurance plans even when deemed medically necessary. In some cases, insurance companies act as gatekeepers for conditions requiring surgery. The present study sought to evaluate nationwide variation of insurance type coverage, as well as out of pocket and total costs for reduction mammoplasty in outpatient setting.
The Truven MarketScan Database was analyzed to identify patients who underwent reduction mammaplasty in an outpatient setting in 2021. Total and out-of-pocket expenses paid for the surgery including deductible, co-payment, and coinsurance were assessed. Furthermore, analysis was performed to evaluate cost variation between the regions. Univariate parametric analysis was applied to evaluate the variation in financial variables across insurance plan types and regions.
A total of 8660 patients were identified who underwent outpatient reduction mammaplasty in 2021. The majority of patients were female (n=8552, 99%) with age range 18-34 (n=3350, 39%) residing in South region (n=4354, 50%). Most patients were insured either through preferred provider organization plan (PPO) (n=4212, 49%) or health maintenance organization (HMO) (n=1153, 13%). The overall median out-of-pocket cost was $523 (IQR $1548) and total payment cost was $8097 (IQR $8245). Out-of-pocket medians did not vary by region (p=0.016) but varied by insurance type (p<0.001). For total cost expenses there was statistical significance for both region and plan type. With highest median total costs in Northeast region ($11023, IQR $11324) and POS ($9923, IQR $11536).
Majority of patients in present study had PPO coverage, with more flexibility in choosing provider or hospital and not requiring specialist referral. Although out of pocket cost did not vary by region, it did vary by insurance type. Insurance companies are becoming increasingly involved in determining medical necessity of surgical procedures and should be aware of the financial burden placed on patients requiring surgical procedures.
Insurance plan variation
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