The North Carolina Blue Cross Blue Shield has agreed to change the recently implemented lumbar fusion policy after several orthopedic and spine societies sent the company a letter recommending coverage for additional situations, according to a Spine Arthroplasty Society news release.
The BCBS-NC implemented a new policy on Jan. 1 that limited or denied surgery for several conditions and diagnoses that were previously considered to necessitate surgery, including degenerative disc disease. Nine state and national orthopedic and spine organizations signed a letter recommending additional coverage.
On Jan. 20, SAS president Tom Errico, MD, and eight other leaders met with BCBS-NC leadership about the policy on spinal fusions. The BCBS-NC's new policy adds coverage on flatback osteotomy fusions and separates pediatric surgeries completely from the guidelines. The company will not pre-authorize fusions in the cases of iatrogenic instability created at the time of compression, but is willing to consider approving the fusions after the fact.
The BCBS-NC is not willing to reverse the decision to deny coverage for pure fusions for DDD, but they have not closed the door on approvals for that on appeal.
Read the SAS news release on the spinal fusion coverage.
Read other coverage on spinal fusions:
- Spinal Fusions Face an Uncertain Future
- The ISASS Defends Spinal Fusions
- Report Investigates Spinal Fusions Performed By Twin cities Spine Surgeons
The BCBS-NC implemented a new policy on Jan. 1 that limited or denied surgery for several conditions and diagnoses that were previously considered to necessitate surgery, including degenerative disc disease. Nine state and national orthopedic and spine organizations signed a letter recommending additional coverage.
On Jan. 20, SAS president Tom Errico, MD, and eight other leaders met with BCBS-NC leadership about the policy on spinal fusions. The BCBS-NC's new policy adds coverage on flatback osteotomy fusions and separates pediatric surgeries completely from the guidelines. The company will not pre-authorize fusions in the cases of iatrogenic instability created at the time of compression, but is willing to consider approving the fusions after the fact.
The BCBS-NC is not willing to reverse the decision to deny coverage for pure fusions for DDD, but they have not closed the door on approvals for that on appeal.
Read the SAS news release on the spinal fusion coverage.
Read other coverage on spinal fusions:
- Spinal Fusions Face an Uncertain Future
- The ISASS Defends Spinal Fusions
- Report Investigates Spinal Fusions Performed By Twin cities Spine Surgeons