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Complications Insured
A New Type of Policy Covers Medical Problems That May Follow Elective Plastic Surgery. Does This Boost Patient Confidence?
By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, February 24, 2004; Page HE01

People who undergo cosmetic surgery already know that their health plan won't help finance elective operations that can cost thousands of dollars. But how many know they may also have to pay for treatment of a serious complication -- a blood clot, an infection, a drop in blood pressure due to anesthesia -- that occurs after surgery?
Increasingly, some plastic surgeons say, patients are finding themselves stuck with these bills because a growing number of health insurers are refusing to cover them. In the past, surgeons say, insurers did not scrutinize such claims as closely and were more generous in paying for treatment of post-operative complications.

"It's a gray area," said Scott L. Spear, chief of plastic surgery at Georgetown University Hospital. "But when it happens what patients say is, 'Not only do I have a complication, but you want me to pay?' "

Uncertainties about reimbursement, coupled with an increase in the number of cosmetic procedures -- more than 2 million Americans underwent cosmetic surgery in 2002, an increase of 6 percent over 2001 -- have resulted in the development of a new kind of insurance that is being peddled to plastic surgeons around the country.

Sold under the name CosmetAssure, the policy, underwritten by insurance giant AIG, offers patients of participating plastic surgeons coverage of up to $240,000 to treat serious medical problems that occur within 30 days of elective cosmetic surgery. The insurance cannot be purchased by individual patients.

"It's an interesting idea, sort of like the travel insurance you buy at the airport before you get on the plane," said Spear, president-elect of the American Society of Plastic Surgeons (ASPS), a group that represents the nation's 5,000 board-certified plastic surgeons.

Spear said that the ASPS is scheduled to consider whether to publicize the insurance to its members.

The $132 insurance fee is dwarfed by the $10,000 or more patients pay out-of-pocket for a face-lift or other major operation.

The policy covers 17 of the most common elective surgical operations, including breast augmentation and liposuction. Multiple procedures performed at the same time are covered under a single fee, but only complications serious enough to require treatment in a hospital are reimbursable.

Surgeons who sign up for coverage pay nothing for the insurance, and usually tack the fee onto their bills. Treatment to redo a botched or otherwise unsatisfactory operation is not covered.

Launched in July 2003, the policy has been approved by regulators in 40 states -- including Virginia -- and the District of Columbia; approval is pending in Maryland. Only board-certified plastic surgeons are eligible to apply.

If a doctor signs up, all of his or her patients are covered in order to spread the risk.

"This is sort of catastrophic coverage," said James Grotting, the Birmingham, Ala., plastic surgeon who developed the concept, which he regards as a "safety net" for patients. Grotting said his interest was sparked in part by the more complicated and extensive operations he and many of his colleagues are performing, increasingly on older patients who may be more prone to complications.

ASPS officials say they currently do not maintain statistics about complications, but are planning to launch such a database within the next year.

Grotting and other surgeons say a growing number of insurance companies are refusing to pay for treatment of problems that arise from elective cosmetic operations, such as a serious infection after a face-lift or a blood clot after a tummy tuck.

While there is abundant anecdotal evidence of payment problems, it's not clear how widespread the problem actually is. Officials at Aetna, the nation's largest health insurance company, and Kaiser Health Plan of the Mid-Atlantic States say they cover "medically necessary" treatment of complications from cosmetic surgery.

Although the coverage seems to be a no-lose proposition for some plastic surgeons, it may not be necessary for their patients.

"This is not a good deal if you've already got coverage, so patients should check with their health plan before surgery," advised J. Robert Hunter, director of insurance for the nonprofit Consumer Federation of America.

Out of Court

For surgeons, such insurance might avert a potentially costly lawsuit.

The CosmetAssure brochure aimed at surgeons pointedly notes that "every profession has unsettling issues." When a postoperative patient learns that care for a complication is not covered, the brochure states, "the patient may turn to the surgeon to cover these expenses, or file a malpractice claim."

Grotting cited one such case of a prominent Tennessee doctor who accidentally punctured a patient's colon during liposuction. The patient spent nine months in the hospital, much of it in the intensive care unit, generating a $1 million bill his insurer refused to cover. In that case, Grotting said, the patient sued the surgeon, who settled the case.

Georgetown's Spear estimates that every three or four years one of his patients suffers a complication serious enough to require rehospitalization, a figure echoed by Grotting.

If the patient's insurance company refuses to pay, Spear and Grotting say, most surgeons probably would ask the hospital administrator to write off the charge. Only in very rare instances, Spear said, would a doctor pay for such treatment out of his or her own pocket.

Gregory Lynam, a Richmond plastic surgeon who recently signed up for coverage, said he thinks it is "a fantastic idea" and will add the $132 charge to his fee. In Lynam's view the cost is small compared to the $4,500 he charges for breast implants, an operation he said some of his patients finance by taking out a home equity loan.

"If I was the patient," Lynam said, "I'd want this insurance."

That was how Ann Bauer said she felt. A month ago the Birmingham, Ala., homemaker underwent a six-hour operation that included a tummy tuck, a lower body lift and liposuction performed by Grotting. The surgery cost $13,000, she said, about $1,000 more than the face-lift and chin implant Grotting gave her last year.

Bauer, 55, said that Grotting waived the $132 fee in her case. She said she was glad to have the protection. "I don't think my insurance would cover it, but frankly it's not even something I had ever thought of," she said. "I think it's a great deal."

Marion Parker, an insurance broker for a Montgomery, Ala., firm that is the exclusive agent for CosmetAssure, said interest in the policy increased dramatically after the Jan. 16 death of Olivia Goldsmith. The author of the best-selling novel "The First Wives Club," Goldsmith died of anesthesia-related complications related to plastic surgery to remove loose skin under her chin.

Parker noted that Goldsmith spent a week in a Manhattan hospital in a coma before she died -- a fact surgeons who called about the policy said prompted them to consider offering it.•

http://www.washingtonpost.com/wp-dyn/articles/A449-2004Feb23.html