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<p>[QUOTE="Anonymous, post: 3271917"]This issue has nothing to do with hospital reimbursement. It has everything to do with surgeons being paid for doing an XLIF. Right now guys are coding it as an ALIF, some dirtbags use a code that pays much higher (extracavitary approach) and insurance companies have been gladly paying the claims without blinking. Because of the current healthcare debate, insurance companies are being much more discriminating in what they accept as a reimbursable procedure. Many of the companies (Cigna, Aetna, Anthem...) have arbitrary criteria for what they will cover, like 2 or 5 year prospective, double blind, peer reviewed outcomes. If the procedure doesn't have that kind of study, it will be considered experimental, and likely recieve a new category 3 tracking code...the kiss of death. Once that happens, you can bet that all insurance companies will decline to cover the procedure. What will happen before that, insurance companies will just ask Dr.'s what specific operation they are performing when they submit the ALIF code. If it is an XLIF, they won't get paid, or will have to ask for a peer review, and probably appeal a denial. This will require all of the lateral approach companies uniting their ample resources, and lobbying the jackholes at NASS to intervene and ramrod an new Class 1 code through to avoid a collapse in the adoption of lateral access surgery. Sorry for the bad news. NUVA stock is either a sell now, or hold for the loooooong term. I hope they have been saving their pennies, because the cash cow has been sent to slaughter.[/QUOTE]</p><p><br /></p>
[QUOTE="Anonymous, post: 3271917"]This issue has nothing to do with hospital reimbursement. It has everything to do with surgeons being paid for doing an XLIF. Right now guys are coding it as an ALIF, some dirtbags use a code that pays much higher (extracavitary approach) and insurance companies have been gladly paying the claims without blinking. Because of the current healthcare debate, insurance companies are being much more discriminating in what they accept as a reimbursable procedure. Many of the companies (Cigna, Aetna, Anthem...) have arbitrary criteria for what they will cover, like 2 or 5 year prospective, double blind, peer reviewed outcomes. If the procedure doesn't have that kind of study, it will be considered experimental, and likely recieve a new category 3 tracking code...the kiss of death. Once that happens, you can bet that all insurance companies will decline to cover the procedure. What will happen before that, insurance companies will just ask Dr.'s what specific operation they are performing when they submit the ALIF code. If it is an XLIF, they won't get paid, or will have to ask for a peer review, and probably appeal a denial. This will require all of the lateral approach companies uniting their ample resources, and lobbying the jackholes at NASS to intervene and ramrod an new Class 1 code through to avoid a collapse in the adoption of lateral access surgery. Sorry for the bad news. NUVA stock is either a sell now, or hold for the loooooong term. I hope they have been saving their pennies, because the cash cow has been sent to slaughter.[/QUOTE]
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Cafepharma Message Boards | Pharma Sales, Device Sales, Lab Sales
Home
Forums
>
Medical Equipment/Device Sales
>
NuVasive
>
Reimbursement Issues
>
Cafepharma Message Boards | Pharma Sales, Device Sales, Lab Sales
Home
Forums
>
Medical Equipment/Device Sales
>
NuVasive
>
Reimbursement Issues
>