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Government Insurance Delays Treatment for Children

When a doctor writes a prescription for a brace, it can be months before the child actually receives it. Type of insurance makes a difference in how long the child must wait. In this study, three types of insurance are compared. Government, health maintenance organizations (HMOs), and preferred provider organizations (PPOs) are included.

Data was recorded by a single orthotic company (brace supplier) providing ankle or trunk braces for 60 children. The number of days between prescription and insurance company approval was recorded. The time between prescription and actually receiving the brace was also tracked. The orthotic company received the prescription the same day it was written. The brace was ready within two weeks of insurance authorization.

The authors report big delays for children covered by government insurance. More expensive (trunk) braces took longer than less expensive (ankle) braces. They had to wait up to four months longer to receive their braces compared to children with PPO coverage. PPOs were faster than HMOs in approving this treatment.

Delays were not all caused by insurance. Once the brace was ready, families with government insurance took three times as long to pick up the braces. Lack of phone service, change in address, and transportation problems may be factors. Language barriers and time off from work may be other problems causing delays.

The authors conclude that access to care and quality of care is based on insurance status. But it's also true that a lack of cooperation on the part of the family has some impact. Finding a way to streamline this process and increase patient compliance are the next steps in delivering treatment on time.

References: David L. Skaggs, MD, et al. Insurance Status and Delay in Orthotic Treatment in Children. In Journal of Pediatric Orthopaedics. January/February 2006. Vol. 27. No. 1 Pp. 94-97.

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