The medical necessity for treatment of port-wine stains.
BACKGROUND
Port-wine stains are congenital vascular malformations that can be disfiguring and may lead to psychosocial as well as medical complications. The 585-nm pulsed dye laser is very effective in treating port-wine stains. Laser treatment is often viewed by insurance companies as a "cosmetic procedure" and not "medically necessary". Consequently many patients are denied coverage for treatment of their disfiguring birthmarks.


OBJECTIVE
To determine variability of insurance coverage for laser treatment of port-wine stains from state to state. Natural history, progression, and potential complications of port-wine stains are reviewed and rationale for consistent insurance coverage for laser treatment of port-wine stains is given.


METHODS
A questionnaire was mailed to 40 dermatologic surgeons in 22 states and the District of Columbia. We reviewed the literature regarding port-wine stains and their potential complications, and health care policy guidelines regarding "medical necessity" and "cosmetic procedures".


RESULTS
Insurance coverage for laser treatment of port-wine stains varies from state to state.


CONCLUSIONS
Based on current health care policy guidelines, laser treatment of port-wine stains should be regarded, and covered, as a medical necessity by all insurance providers.
McClean
K
K
Department of Dermatology, Indiana University School of Medicine, Indianapolis 46202, USA.
Hanke
C W
CW
D000367:Age Factors; D062109:Dermatologic Surgical Procedures; D018450:Disease Progression; D004219:District of Columbia; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D007348:Insurance, Health; D017075:Laser Coagulation; D019339:Port-Wine Stain / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012867:Skin / Q000473:pathology; D013518:Surgery, Plastic; D011795:Surveys and Questionnaires; D014481:United States