Pectus excavatum surgery

Pectus excavatum surgery is a thoracic procedure that corrects sunken chest deformity by repositioning the sternum, most commonly using the Nuss or Ravitch techniques. Most U.S.

Insurance companies, such as Blue Cross Blue Shield and Aetna, cover pectus excavatum surgery if medical necessity is proven with objective evidence like CT scan indices (Haller index >3.25) and documented cardiopulmonary impairment. Insurers typically require preauthorization for pectus excavatum surgery, demanding documentation from pulmonologists or cardiologists showing symptoms including exercise intolerance or reduced lung function (e.g.

FEV1 <80%). Out-of-pocket costs for insured patients undergoing pectus excavatum surgery in the U.S.

Range from $2,000 to $5,000 depending on deductible and coinsurance rates; uninsured costs can exceed $40,000 at hospitals like Mayo Clinic or Cleveland Clinic, as stated by YourInsurance.info (Your Insurance Info). Insurance denials for pectus excavatum surgery often cite cosmetic classification unless functional impairment is clearly demonstrated through tests such as echocardiograms or pulmonary function studies.

Appeals for denied coverage of pectus excavatum surgery succeed more frequently when supported by peer-reviewed literature and detailed physician letters outlining physical limitations caused by the deformity. Pectus excavatum revision surgeries are covered less consistently than primary repairs; insurers may require proof of hardware failure or persistent physiological compromise via imaging (CT/MRI).

Coverage policies differ between Medicaid programs in states like California versus Texas–some restrict approval to severe cases only–so patients must verify criteria directly with their plan administrators before scheduling consultation appointments.