The effect of medical insurance coverage on the obtainment of pressure garments

Pressure garments are used to alter the appearance of immature burn scars. These garments are costly and delays in obtaining them are frequent. The pu rpose of the: study was to determine the nature of the delays in the obtain ment of pressure garments and to examine the role that the paver plays in t hese delays. The billing and medical records of all patients with burns mea sured for pressure garments between January 1, 1998, and August 1, 1999, we re reviewed. The distribution of pavers was as follows: workers' compensati on, 37%; state-funded insurance, 32% health maintenance organizations, 12%; private insurance, 16%; and other, 3%. Payment authorization time for pres sure garments was 37 days for state payers and less than 10 days for all ot her groups. Patients with state-funded insurance waited an average of 67 da ys to receive their garments as opposed to a wait of 20 to 30 days for othe r 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 out come.