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Laya Healthcare recommences cover for benign skin lesions in primary care

By Dermot - 23rd Oct 2017

The change was recently communicated to GPs following talks between the insurer, the Primary Care Surgical Association (PCSA) and the HSE National Cancer Control Programme (NCCP).

In a statement, a spokesperson for Laya said that following consultations with the NCCP regarding best practice guidelines for melanoma managemement and further to talks with the PCSA, its medical advisory panel and several GP representatives, it had revised its schedule of benefits to include a new procedure code (Code 22) for the excision of benign skin lesions in a primary care setting.

“Where the excision of benign skin lesions is deemed medically necessary, the cost will be covered, subject to a member’s scheme. In these instances, relevant documentation is provided by the GP and detailed on the claim reimbursement form, confirming that specific risk factors or significant medical conditions are present to qualify for the excision of the benign skin lesion,” said the spokesperson.

“In accordance with clear guidelines from the NCCP, and our own medical advisors, a condition of this benefit is that all lesions excised are sent for histological investigation. The change to our schedule of benefits was communicated to GPs on 12 October 2017.”

Speaking to the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>), Chairman of the PCSA, GP Dr Niall Maguire, welcomed the development as an end to what he described as an “unhappy debacle”.

A previous Laya code relating to the excision of skin lesions, Code 23, was pulled in August. The move was in response to correspondence from the NCCP issued to all insurers in relation to its policy on suspicious pigmented lesions.

It is understood that Laya felt Code 23 could be in conflict with NCCP guidance, but following talks the development of Code 22 has eliminated concern, it is understood.

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