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Some Insurance Companies Deny Coverage Of Facial Reconstruction After Trauma

I noticed this article title on MDLinx, then went to the Journal of Plastic and Reconstruction website to read the full article.  The abstract is free to read, the full article requires a subscription.

The study was prompted by the authors noticing third party insurers increasingly deny coverage to patients with post traumatic and congenital facial deformities.  This denial is often cited as due to the deformities not being seen as “functional” problems.  The authors cite the recent facial transplants patients as having demonstrated  that the severely deformed are willing to undergo potentially life-threatening surgery and extended chemotherapy in an attempt in look normal.

The authors also noted that very little research exists which objectively documents appearance as a primary “function” of the face.  To this end, they designed their study to “establish a population-based definition of the functions of the human face, rank importance of the face among various anatomic areas, and determine the risk value the average person places on a normal appearance.

Their method involved using  210 voluntary adult subjects in three states aged 18 to 75 years who then completed study questionnaires.  Quota sampling technique was used to select the subjects.  The study questionnaires of demography and bias were done using Gamble Chance of Death Questionnaire and Rosenberg Self-esteem Scale.

Their results:

Subjects ranked appearance as number 5 above expression (number 6), and smell was least important.

Subjects ranked the face as the most important body part to restore after an injury followed by the hand, leg, arm, knee and breast.

Chewing was regarded by most subjects (88%) to be a basic function of the face with over half of subjects (57%) rating appearance as a basic function, and 43% of respondents rating beauty.

68% disagreed with the statement  “Normal facial appearance is not important to be a normal functioning member of society.”

17% of subjects agreed with the statement “Normal facial appearance is irrelevant to being a normal functioning member of American Society”.

A large majority of subjects (72%) determined that surgery to normalize the appearance of facial scars from an accident was functional, as compared to those subjects who thought it was non-functional or not necessary (28%).

Most subjects (79%) reported that surgery to normalize the appearance of facial birth defects was functional, while 21% reported that it was not necessary or non functional; and 72% of the respondents agreed that surgery to normalize the appearance of facial scars from an infection was functional.

The highest ranking of agreement regarding surgery was to normalize the appearance of facial nerve injury; 90% of subjects agreed it was functional while only 10% of subjects agreed it was non-functional.

The authors call this a large sampling, but I don’t feel that 210 subjects is a large sampling.  I would like to see this study repeated with minimally 10 times the number of subjects.  If they want to change insurance policy, I think bigger numbers will be needed.

REFERENCE

Appearance Is A Function of the Face; Plastic and Reconstructive Surgery: POST ACCEPTANCE, 1 December 2009; Borah, Gregory L. MD, FACS; Rankin, Marlene K. PhD; doi:10.1097/PRS.0b013e3181cb613d

*This blog post was originally published at Suture for a Living*


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