Document Detail


The effect of medical insurance coverage on the obtainment of pressure garments.
MedLine Citation:
PMID:  11020048     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pressure garments are used to alter the appearance of immature burn scars. These garments are costly, and delays in obtaining them are frequent. The purpose of the study was to determine the nature of the delays in the obtainment of pressure garments and to examine the role that the payer plays in these delays. The billing and medical records of all patients with burns measured for pressure garments between January 1, 1998, and August 1, 1999, were reviewed. The distribution of payers was as follows: workers' compensation, 37%; state-funded insurance, 32%; health maintenance organizations, 12%; private insurance, 16%; and other, 3%. Payment authorization time for pressure garments was 37 days for state payers and less than 10 days for all other groups. Patients with state-funded insurance waited an average of 67 days to receive their garments as opposed to a wait of 20 to 30 days for other payers. The percentage of billed charges paid was least for patients with state-funded and HMO insurance (58% and 51%, respectively). The interval to payment of charges was longer than 60 days for all groups. Marked delays in authorization exist for state-funded reimbursement of pressure garments. Reimbursement for patients with state- and HMO-funded insurance was lower than for other payers. These differences may have an adverse effect on outcome.
Authors:
T L Palmieri; D Kayden; D G Greenhalgh
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of burn care & rehabilitation     Volume:  21     ISSN:  0273-8481     ISO Abbreviation:  J Burn Care Rehabil     Publication Date:    2000 Sep-Oct
Date Detail:
Created Date:  2001-01-08     Completed Date:  2001-02-01     Revised Date:  2006-08-15    
Medline Journal Info:
Nlm Unique ID:  8110188     Medline TA:  J Burn Care Rehabil     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  414-6     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of California Davis Burn Center, Sacramento, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Bandages / economics*
Burns / economics*,  rehabilitation,  therapy*
Cicatrix / prevention & control
Clothing
Female
Health Maintenance Organizations*
Health Services Accessibility
Humans
Insurance, Health / economics*,  statistics & numerical data
Insurance, Health, Reimbursement / economics*
Male
Private Sector
Public Sector
Retrospective Studies
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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