BCBS Anthem update: Two-Level Cervical ADR Covered

[RiverMiles]

BCBS Anthem now covers 2LVL ADR for Cervies.

This is not the same policy change that took place (in June?) for BCBS in a portion of its footprint including Texas, Montana, Illinois, New Mexico, and Oklahoma.

My understanding is Anthem is one of the remaining "elephants" that LDR has been working on and that this policy change represents a significant leap in the number of patients covered for this procedure.

Anthem BCBS is not my insurer and I'm sure someone else could speak to this better than me but I believe their footprint adds members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, Wisconsin?

This policy change went into effect on 8/18. The link below takes you to the policy brief - See the second paragraph under the heading, "Position Statement."

Sorry in advance if this is already posted but I couldn't find it anywhere else and I wanted to post it as soon as I could confirm.

https://www.anthem.com/medicalpolici...pw_a053354.htm

[Harrison]

Thank you, for sharing this important information!

[Sportinawoody]

Is this particular to certain states? Pardon the ignorance but I'm new to this.

[RiverMiles]

And I'm new at this too but I think this applies to group plans within the entire Anthem/BCBS footprint, so all states within their footprint. My understanding is the medical policy bulletins are meant to be fairly universal within a given plan. It's possible there could be an exception/exclusion written into a specific employer's plan language. If so you might be able to find that information in the summary plan description (SPD) for your plan.

So for cervical two levels the big players who are now on board include Anthem/BCBS, United Healthcare, Cigna, and some other tendril of BCBS that covers Texas, Montana,* Illinois,* New* Mexico,* and*Oklahoma. I don't think any of the BCBS federal plans cover disc replacement, only group plans. I think for Cigna and UHC two level coverage exists for both the federal and group plans. Just putting that out there because open enrollment is right around the corner.

Does that help at all/answer your question? Are you researching prospective plans or trying to determine coverage for your current plan?

[RiverMiles]

But it would apply to the Anthem BCBS plans. BCBS has so many independent licensees and somehow a procedure that Anthem BCBS calls a new gold standard might be called experimental/investigational by Wellmark BCBS.
Sorry for the emphasis on cervies; just checked out your profile. Do you have BCBS-NC?

[Tatonka_usn]

Originally Posted by RiverMiles

I don't think any of the BCBS federal plans cover disc replacement, only group plans.

Any idea if there's been additional clarification on this? I have Blue Cross FEP, and am at the point of considering ADR for cervical issues.