THE MEDICAL NECESSITY FOR TREATMENT OF PORT-WINE STAINS

BACKGROUND. Port-wine stains are congenital vascular malformations tha t can be disfiguring and may lead to psychosocial as well as medical c omplications. The 585-nm pulsed dye laser is very effective in treatin g port-wine stains. Laser treatment is often viewed by insurance compa nies as a ''cosmetic procedure'' and not ''medically necessary.'' Cons equently many patients are denied coverage for treatment of their disf iguring birthmarks. OBJECTIVE. TO determine variability of insurance c overage for laser treatment of port-wine stains from state to state. N atural history, progression, and potential complications of pork-wine stains are reviewed and rationale for consistent insurance coverage fo r laser treatment of port-wine stains is given. METHODS. A questionnai re was mailed to 40 dermatologic surgeons in 22 states and the Distric t of Columbia. We reviewed the literature regarding port-wine stains a nd their potential complications, and health cave policy guidelines re garding ''medical necessity'' and ''cosmetic procedures.'' RESULTS. In surance coverage for laser treatment of port-wine stains varies from s tate to state. CONCLUSION. Based on current health care policy guideli nes, laser treatment of port-wine stains should be regarded, and cover ed, as a medical necessity by all insurance providers. (C) 1997 by the American Society for Dermatologic Surgery, Inc.