title: Insurance status and delay in orthotic treatment in children.
abstract: OBJECTIVE
  To determine if the type of health insurance is associated with a delay in children obtaining orthoses.
  
  
  METHODS
  The medical records of 60 children who were prescribed an ankle-foot orthosis (AFO) or thoracolumbosacral orthosis (TLSO) were retrospectively reviewed. Ten children were randomly chosen with either of 3 types of insurance (government, health maintenance organizations [HMOs], and preferred provider organizations [PPOs]) with an orthosis provided by a single supplier. The time interval between prescription and insurance company authorization was recorded, as well as the interval between prescription and procurement of the orthosis.
  
  
  RESULTS
  There were significant differences in the time from prescription to authorization of orthoses between insurance types (P = 0.001) and time from authorization until brace procurement between insurance types (P = 0.01). Children with PPO insurance received authorization for an AFO faster than children with government insurance or an HMO (P < 0.05). Children with government insurance received authorization for a TLSO significantly later than children with PPO insurance (P = 0.004) or HMO insurance (P = 0.03). The difference in time between authorization and procurement of a TLSO in children with PPO insurance (36 days) was strikingly different from that of children with government insurance (123 days) (P = 0.003).
  
  
  CONCLUSIONS
  This study documents that children with government insurance face delays in obtaining orthotic treatment compared with children with PPO insurance. The delay in the procurement of the more expensive brace (TLSO is approximately 4 times the cost of an AFO) correlated to more striking delays in the government-insured population.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles and University of Southern California, Keck School of Medicine, Los Angeles, CA 90027, USA. dskaggs@chla.usc.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.forename: Jon E
authors.initials: JE
authors.lastname: Oda
authors.forename: Larry
authors.initials: L
authors.lastname: Lerman
authors.forename: Erik
authors.initials: E
authors.lastname: McGoldrick
authors.forename: Christie
authors.initials: C
authors.lastname: Rice
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weiss
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kay
mesh_terms: D002648:Child; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D009989:Orthotic Devices / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors