United Healthcare and ADR/TDR

[colorado2718]

UHC is my insurance company and I found a link to their "Artificial Total Disc Replacemetn for the Spine" Medical Policy statement that has me concerned. The link for this document follows:

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Artificial_Total_Disc_Replacement_for_the_Spine.pd f

This policy statement says "Artificial total disc replacement is unproven for the treatment of single or multiple level degenerative disc disease of the lumbar spine in skeletally mature patients."

This is a 15 page document that covers quite a bit of good information but in the end, despite the encouraging data, they conclude that the sample sizes are too small, some trials weren't controlled well enough and there hasn't been enough time or study to make a determination on the efficacy of ADR/TDR.

When I read this document, it seems to imply that ADR/TDR wouldn't be covered by UHC, but it doesn't actually say this anywhere that I can find.

I did some searching on this forum, but didn't find and answer to my question about whether or not UHC will cover ADR/TDR - do any of you know the answer to this?

Thanks for your help!

[prusinski]

Hey Colorado,

I'm working both streams for ADR against UHC, my private carrier and Travelers, my WC carrier from Illinois. I'm a Wisconsin resident and the surgical team at Rush University Hospital asked me to work with them to push preauthorization from both carriers to see which breaks first. This is the plan because WC is so time consuming.

I'll provide feedback when it occurs. Right now, I'm working on my first appeal to UHC. I'll post PRN.

Thanks,

Bob