Blue Cross Coverage of XLIF in Michigan

I have heard that Blue Cross Blue Shield has deemed XLIF experimental. Any truth to this?

 

Even after they lobbied hard to get Cigna to approve of this type of procedure, Cigna says this:

""there are few published studies examining clinical outcomes, such as functional ability and successful fusion rates, following DLIF/XLIF procedures. ""

www.cigna.com/customer_care/healthc...ria_lumbar_fusion_degenerative_conditions.pdf


Cigna also MANDATES when a XLIF is done, they have to use 'Fixation'....bolt the vertebrae together.

Nuvasive has been advertising and pushing Surgeons to do XLIF's without using Fixation. (To make fast money).

XLIF isn't experimental. They KNOW putting a plastic spacer between someones vertebrae without using FDA approved Fixation= Bad Outcome.

 

Last time I checked, NuVasive also makes the hardware to "bolt the vertebrae together" and that part can bill out for more than the cage. Seriously doubt they are pushing for standalone use.

 

Nuvas's been advertising since its inception that XLIF is to be done WITHOUT Fixation....even though their FDA Approval Letter for the Coroent XL says......Fixation Required.


The Coroent XL is not an artificial disc. It was never approved to be used alone by the FDA.

But Nuva's marketed it and tricked surgeons to use it alone to make fast $$$$.


Where was the Fusion?

 

The fusion occurs inside the cage, provided there is bone graft in it.

I used to work for NuVa, and they NEVER told me to push standalone use. There is too much money lost by not putting in a plate/screws or pedicle screws/rods. That part bills out 50% or higher than the cage alone.

The standalone business model makes no sense.

 

Thanks Ed M, at least be honest and admit you still work for nuva. Dr X to Ed M "I'm sorry i dont believe xlif is an mis procesure. why would i go lateral then flip and put screws in if I can achieve both posterior? koolaid drinker "Dr. you dont know what your talking about we have a lot of surgeons doing this standalone because of the big footprint and preservation of the ant post ligaments, just ask Dr. S he does it all the time. Hmmmm - FDA who

 

They're whole business model was based upon a quickie procedure but billing for a full spine fusion under the proper Insurance Code.....for a full fusion. When they never did a fusion.

Nuva was pushing that their procedure didn't need "Fixation". Many of the patients who got the procedure without fixation....still are not fused. 2011 there were some Medical Journal articles stating when patients didn't get fixation.....their outcomes were bad.

The goo they were putting inside the plastic block to kickstart bone growth....ain't as good as they tried to make it out to be. Osteocell recall 2009....ouch.

All the Nuva advertisement videos show their procedure being done...without fixation. It was their 'One Trick Pony' they were pushing for surgeons to make super fast money.......Federally endorsed of course.

 

Current Policy Effective Date: 5/1/12
Title:
Minimally Invasive Lumbar Interbody Fusion
Medical Policy Statement
The safety and effectiveness of minimally invasive interbody fusion of the lumbar spine have been established when using the following approaches:

Anterior lumbar interbody fusion (ALIF)

Posterior lumbar interbody fusion (PLIF)

Transforaminal lumbar interbody fusion (TLIF)
All other minimally invasive procedures for lumbar interbody fusion are considered experimental and investigational, including, but not limited to the following:

Laparoscopic ALIF (LALIF)

Axial anterior lumbar interbody fusion (AxiaLIF)

Lateral interbody fusion (e.g., XLIF, DLIF)

 

Looks like they are lobbying Blue Cross to stop saying XLIF is "Investigational" and allow their customers to get it:

http://www.aans.org/pdf/Legislative...omments_Michigan_BCBS_Spine_Fusion_050112.pdf


Interesting letter. Do you think XLIF patients with infections post surgery/ pseudarthrosis are under reported? I'd say yes.

Where's the Fusion?