4 payer updates for orthopedic surgeons to know

Alan Condon -   Print  |
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From a revived spine surgery lawsuit over one insurer's policy to two orthopedic practices inking value-based contracts in Florida, here are four commercial payer updates for surgeons to know:

1. A lawsuit over Aetna Life Insurance's spine surgery coverage that was originally dismissed in 2019 is now moving forward. The case relates to two patients covered by Aetna who were recommended lumbar artificial disc replacement surgery — Aetna allegedly denied both requests, saying the procedure was "experimental or investigational."

2. Philadelphia-based Rothman Orthopaedic Institute contracted with Cigna for in-network value-based care for the practice's Florida offices. The practice had a longstanding relationship with Cigna prior to the deal, which gives Cigna members in-network care at Rothman facilities effective June 1.

3. The Orthopaedic Institute in Gainesville, Fla., signed a contract for bundled payments with Florida Blue Cross Blue Shield. The agreement took effect May 25 and focuses on total and partial first-time elective joint replacements.

4. Payers are expanding coverage for minimally invasive sacroiliac joint fusions after CMS upped the reimbursement rate for the procedure by 27 percent in January 2020. Humana, Aetna, and Medica have all revised coverage policies to include MIS SI joint fusion in the past year.

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