Motion-preserving spine techniques can improve the quality of life for more people, but insurers remain a significant hurdle for surgeons, Jared Ament, MD, said.
In new milestones, Dr. Ament debuted procedures combining disc replacement and facet replacement. He spoke with Becker’s about the challenge he faces with payers and how physicians and patients can approach them.
Note: This conversation was edited for clarity and length.
Question: For disc replacement, it’s been a bit of an uphill battle for spine surgeons in terms of insurance coverage. With these new cases, how has it been on that side?
Dr. Jared Ament: It’s considered very experimental, and the payers are for-profit entities. We’ve had some better luck with the artificial disc of late. Sometimes we can get the artificial disc component of the surgery covered but not for the artificial facet. Sometimes the entire thing is just not covered. That’s the biggest impediment to enrollment in our trial. It hasn’t been a desire or patient pathology. The need is there. There’s a significant need, but it has been a financial impediment, because right now this is an experimental trial, and patients have to be able to afford it because no one’s sponsoring it or funding it because it’s considered off label use even though the FDA allows us legally and ethically to do it.
Insurance companies love the off label thing because that’s an opportunity for them to deny. With artificial discs, even if it’s on label they’ll make some reason [to deny coverage]. It’s very expensive and sometimes prohibitive for patients. In cervical disc replacement the FDA approved it for two levels, but lots of people use it for multi-level cases. The insurance company will say that their policy is one or two levels and no more. If you do a hybrid case, then it’s not covered despite data existing for years overseas and early data from our work.
When [nonsurgical management] fails and patients come for a surgical evaluation and the insurance company denies it, a lot of these patients end up becoming addicted to opiates and pain pills, and it becomes a disaster.
Q: What will it take to clear this insurance obstacle and hopefully help this grow?
JA: It’s going to take the few brave and financially able individuals who have signed up for the trial. We’re going to continue pushing forward and publish long-term results. We’re going to keep doing our job to push the frontiers of motion preservation forward.
Honestly, it’s a little bit of an aggressive approach. We have to shove it down their throats. We have to show the insurance companies that the data speaks for itself. You can’t ignore it, and we’re just going to keep showing it.
It’s a combination of us showing them the data, letting the data speak, and patients advocating for themselves. The patients are their clients. The patients subscribe to the insurance companies. So it’s going to be what I call the Blitz approach. We’re going to attack from both sides with the patients and with data.
