New Study Exposes Quality Gaps in Policies
 

Our surgeon, Dr. Jens Chapman put out a press release from the AOSNA that points out the glaring wrong of the recent (2010) medical policy changes by Milliman that excludes many patients from getting fusion or any surgical care for low back pain.

He and others are starting to realize the professional impact this is posing to their practice, their contracts with payers and the care they can offer their patients.

He gave us a fiercely eloquent letter written to our insurance company on our behalf (his 3rd) outlining this error in policy making. He encouraged us to continue fighting anyway we could to bring this matter to light. We will be using the letter to attempt to engage the media, Insurance Commissioner, our local insurance group of the larger issues at hand, along with the press link below.
I know this is not ADR specific but does speak to part of the reason so much of us are leaving the country to get care for our spines.

New Study Exposes Quality Gaps in Policies and Guidelines that Influence Patient Access for Chronic Low Back Pain Care

Thanks for posting - and I saw your other post too about your surgeon. The whole reason I had to go abroad was that my ins co wouldn't pay for fusion and I had contraindications to a prodisc. I had no other option... the whole thing is very frustrating, and despite all of this, there are still pts having surgery who shouldn't, and it's costing us a ton of money as a nation. There aren't enough good, unbiased studies about LBP, DDD, etc to guide surgeons, pts, or ins co's. Ugh.

I know your frustration!
 

It's all very sick, our health care system.
It was only throughout the appeal process did we come to understand who writes the medical policies and how inadequate they are for the job.
I am happy to see increased awareness in WA state from surgeons of the real issue at hand and hoping this awareness will spread regardless of what I end up choosing to do for my spine.
In fact, during our final 4th appeal with Association of Wa Cities, since we don't expect that our denial will be overturned we will use this a platform to share this new study and the issues it brings to light.
my doc had this to say in his email last night....

"Unilateral change by the payers is detrimental to our patient care.
I am bothered payers can make such dramatic moves without having to reopen our contracts.

It is under the guise of quality.
The correct way toward this goal would be to sit in the room with leaders in
Spine Care, recognize that UW Medicine is committed to the best in care, and
determine a go forward that does not put in place hard stops but rather
helps converge on what is appropriate and what is not."

I'm considering posting his letter that speaks to this directly. I guess if he CC'd regence then it is fairly public, right? Anyway he sums up the situation pretty well in the letter.
Baby steps, right?

Kicked off spine boards
 

I posted the same message as above to 2 other spine boards and they kicked me out. Can't log in and won't respond to my email asking why either!
I guess Spine Patent Society and Spine Health don't want patients to know about these issues?
Makes me wonder who owns those boards. FYI

don't know anything about the Spine Health board, but no idea why that would cause an issue at SPS...

Shay

Personally, I don't belong to any other forum.
People on here seem honest and helpful.
I figured the more places I joined, the more
I would get paralysis by analysis.
Too many opinions makes it hard to come to a
decision.