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  • whygoelswhere whygoelswhere Nov 30, 2009 4:23 PM Flag

    Why the CC on Reimbursement?

    Aetna, Cigna, and United Health Group have all listed XLIF as an investigational procedure, making their official national stance that they won't pay for XLIF unless special prior authorization is obtained prior to surgery.

    On a practical basis though all indications are that doctors are still getting paid for a few reasons. First national coverage decisions take a while to get to the local level and secondly, but more importantly doctors bill insurance companies under the code for ALIF so it is extremely difficult for an insurance company to deny coverage automatically. This doesn't mean its not a deterrent for doctors after all would you want to bill 100 XLIFs as ALIFs and then get audited and have to write a huge check back to the insurance company? To make matters worse competitors like Medtronic, Synthes, and JnJ are launching competitive lateral approach products, none of which are specifically called out in any of the insurance company coverage decisions, meaning technically a surgeon could do a lateral approach procedure and not be violating the policy.

    I doubt NUVA will see their procedures dry up overnight due to this little dust up, but it could make it way harder to maintain their growth, and getting good clinical data is going to be expensive.

 
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