The Fractured Insurance Landscape of Laser Therapy for Scar Revision

Fractional laser therapy improves skin texture, range of motion, and quality of life for patients with traumatic scars. Nevertheless, anecdotal evidence suggests declining insurance coverage for laser therapy. We aimed to characterize the landscape of insurance coverage for fractional laser therapy present our six-year reimbursement trends. We cross-sectionally analyzed the 60 largest American health insurers by enrollee size and market share. For each, we identified their laser therapy policy for scar revision and extracted their documentation, prior, and continuing authorization requirements and treatment guidelines. We also collected retrospective institutional claims data from 2017 to 2022 to investigate trends in reimbursement. Of the 60 largest health insurers, we identified 11 (18.3%) policies on scar revision and 40 policies (66.7%) on reconstructive surgery, including scar revision. Nineteen policies considered laser therapy medically necessary with evidence of functional impairment refractory to prior treatment. Three insurers denied laser coverage under any circumstance. Of the 1,531 claims submitted by our institution for burn scar laser therapy, 13.8% were denied. Patients with Medicare (ORadj, 3.78) or Medicaid (ORadj, 2.80) had significantly greater odds of coverage than privately insured patients (p<0.01). There was a 14.5% annual reduction in the odds of reimbursement during the study period (ORadj, 0.86, p < 0.01). Laser therapy is a powerful treatment that is not widely available to patients with traumatic scars. Our institutional data suggest this access may be further eclipsed by decreasing trends in coverage since 2017. Strategies are needed to protect patient access to this life-changing treatment.