Abstract：
Lymphedema affects >1 in 1000 Americans, most often resulting from breast cancer surgery. Conservative treatment, such as compression garments, combined decongestive therapy (CDT), and pneumatic compression pumps, is the current standard of care. Despite the wide availability of these therapies, lymphedema has remained undertreated worldwide. We investigated whether third-party insurance coverage might be a barrier to obtaining conservative treatment in the United States.
We conducted a cross-sectional analysis of publicly accessible insurance policies. A total of 58 insurers were included in accordance with their state enrollment data and market share. The analysis was conducted using a web-based search and individual telephone interviews. For those policies that extended coverage, the medical necessity criteria were abstracted.
A total of 50 insurance companies (86%) had a policy in place addressing conservative management. Included in 37 policies (64%), compression garments were covered the least often (n = 33; 89%). Although CDT was included in only 22 policies (38%), it was universally covered. Noncalibrated pneumatic compression pumps were the most frequently addressed intervention (n = 46; 79%), significantly more often than CDT (P < .01) and were universally covered, significantly more often than were compression garments (P < .04). Criteria for reimbursement were present for more than one half of the policies that provided coverage.
A large proportion of U.S. insurers provided coverage for conservative treatment of lymphedema. However, only 38% of the policies included a statement of coverage for CDT. Most of the policies that did provide coverage for these four therapies also had multiple criteria that were required to be met before considering reimbursement. These requirements could create barriers to the receipt of treatment.
We conducted a cross-sectional analysis of publicly accessible insurance policies. A total of 58 insurers were included in accordance with their state enrollment data and market share. The analysis was conducted using a web-based search and individual telephone interviews. For those policies that extended coverage, the medical necessity criteria were abstracted.
A total of 50 insurance companies (86%) had a policy in place addressing conservative management. Included in 37 policies (64%), compression garments were covered the least often (n = 33; 89%). Although CDT was included in only 22 policies (38%), it was universally covered. Noncalibrated pneumatic compression pumps were the most frequently addressed intervention (n = 46; 79%), significantly more often than CDT (P < .01) and were universally covered, significantly more often than were compression garments (P < .04). Criteria for reimbursement were present for more than one half of the policies that provided coverage.
A large proportion of U.S. insurers provided coverage for conservative treatment of lymphedema. However, only 38% of the policies included a statement of coverage for CDT. Most of the policies that did provide coverage for these four therapies also had multiple criteria that were required to be met before considering reimbursement. These requirements could create barriers to the receipt of treatment.
摘要：
淋巴水肿影响超过1000个美国人，最常导致乳腺癌手术。保守治疗,如压缩服装，联合减充血疗法（CDT），和气动压缩泵，是目前的护理标准。尽管这些疗法广泛可用，淋巴水肿在世界范围内仍未得到充分治疗。我们调查了第三方保险是否可能成为在美国获得保守治疗的障碍。
我们对公众可获得的保险单进行了横断面分析。根据其州注册数据和市场份额，共包括58家保险公司。该分析是使用基于网络的搜索和个人电话采访进行的。对于那些扩大覆盖范围的政策，提取了医疗必要性标准。
共有50家保险公司（86%）制定了解决保守管理的政策。包括在37份保单(64%)中，压缩服装被覆盖的次数最少(n=33；89%)。尽管CDT仅包含在22项政策中（38％），它被普遍覆盖。未校准的气动压缩泵是最常见的干预措施（n=46；79％），明显高于CDT(P<.01)，并且被普遍覆盖，显着高于压缩服装（P<.04）。在提供保险的保单中，有一半以上存在偿还标准。
很大一部分美国保险公司为淋巴水肿的保守治疗提供保险。然而,只有38%的保单包含CDT的承保声明。大多数为这四种疗法提供保险的政策也有多个标准，在考虑报销之前需要满足这些标准。这些要求可能会对接受治疗造成障碍。
我们对公众可获得的保险单进行了横断面分析。根据其州注册数据和市场份额，共包括58家保险公司。该分析是使用基于网络的搜索和个人电话采访进行的。对于那些扩大覆盖范围的政策，提取了医疗必要性标准。
共有50家保险公司（86%）制定了解决保守管理的政策。包括在37份保单(64%)中，压缩服装被覆盖的次数最少(n=33；89%)。尽管CDT仅包含在22项政策中（38％），它被普遍覆盖。未校准的气动压缩泵是最常见的干预措施（n=46；79％），明显高于CDT(P<.01)，并且被普遍覆盖，显着高于压缩服装（P<.04）。在提供保险的保单中，有一半以上存在偿还标准。
很大一部分美国保险公司为淋巴水肿的保守治疗提供保险。然而,只有38%的保单包含CDT的承保声明。大多数为这四种疗法提供保险的政策也有多个标准，在考虑报销之前需要满足这些标准。这些要求可能会对接受治疗造成障碍。
