27934 Unpaid insurance claims associated with the treatment of alopecia areata and lichen planopilaris

Abstract

Intralesional corticosteroid injections are frequently used off-label treatments for noncicatricial and cicatricial alopecias. These diseases are frequently associated with underlying systemic disease and devastating effects on patients’ quality of life and self-esteem. Despite this, obtaining insurance coverage for medical treatments may be a challenge in some cases. The purpose of this study was to investigate unpaid insurance claims for visits involving the use of intralesional corticosteroid injections in those with alopecia areata and lichen planopilaris at one academic health center. The University of Minnesota adult medical dermatology clinics billing data from fiscal years June 2018-December 2020 was searched for the following diagnostic and injection codes: alopecia areata, unspecified (ICD-9 L63.9), lichen planopilaris (ICD-9 L66.1), injections into skin lesions (CPT 11900), and added skin lesions injection (CPT 11901). 919 bundled claims were identified, and 40 insurance claims were unpaid (4.3%). The 40 unpaid insurance claims amongst specific diagnosis codes include: alopecia areata, unspecified 26/604 (4.3%), and lichen planopilaris 14/315 (4.4%). The 40 unpaid insurance claims by CPT codes include: 11900, 5/154 (3.2%) and 11901, 35/765 (4.6%). Upon review of our data, 4.3% of bundled insurance claims were unpaid. This suggests that intralesional corticosteroid injection coverage for patients with alopecia remains a challenge for a small group of patients. One limitation of this study was the inability to unbundle payments amongst paid claims. Therefore, unpaid insurance claims may remain undetected for intralesional corticosteroid injections amongst the bundled payments. Additional research is needed to break down bundled payments and assess for injection coverage.