Beyond the Burn: Evaluating Insurance Support for Cosmetic Reconstruction After Burn Injury.

Abstract

Patients recovering from burn injuries face long-term psychological, physiological, and biomechanical challenges due to scarring. While interventions to address these challenges exist, insurance coverage is often limited. This study examines the insurance policies of major health insurers regarding cosmetic reconstruction (CR) following burn injuries. A comprehensive review of coverage policies was conducted for five major health insurance providers: UnitedHealth Group, Elevance Health (formerly Anthem), Humana, CVS (Aetna), and Centene Corporation. The review focused on invasive and noninvasive CR interventions for burn injuries. Data was collected from state-specific insurance documents using Microsoft Excel. As of 2024, UnitedHealth Group holds a 28% share of the Medicare Advantage market and 14% of the commercial market, serving all 50 states. Humana controls 18% of the Medicare Advantage market, while CVS (Aetna) holds 11% in both markets, with nationwide coverage. However, none provide coverage for CR unless there is documented significant functional impairment (FI). Elevance Health has limited coverage in 19 states, contingent on FI documentation, while Centene Corporation. covers CR on a case-by-case basis, leading to fragmented access across the United States. Standardized, equitable coverage for burn-related CR is needed to remove bureaucratic barriers hindering survivors' recovery. Inconsistent insurance policies prevent access to essential aftercare, exacerbating physical and emotional burdens. Policy reform is crucial to ensure all burn survivors receive the care needed for recovery and a restored quality of life.