Aetna declines to modify payment policy despite pleas from radiology societies
Aetna has declined to modify its payment policy for a key interventional procedure despite pleas from radiologists and other physicians.
Nearly a dozen medical groups sent a letter to the Hartford, Connecticut-based insurance giant a year ago, asking it to reconsider restrictions on treatments for fractured vertebrae. The American College of Radiology—alongside similar groups representing neuro, spine and interventional radiologists—previously criticized policies created by Aetna and other payers, which forbid coverage for such minimally invasive surgery in the initial days after an injury.
Aetna completed a review of the policy on May 15 and has opted to keep it unchanged.
“Our policy reflects the view that conservative management be tried prior to consideration invasive procedures, given the potential for surgical complications,” the insurer said in a letter to the radiology societies.
ACR, the American Society of Neuroradiology, the American Society of Spine Radiology and the Society of Interventional Radiology fired back in a May 21 response. While nonsurgical management remains a treatment option for vertebral compression fractures, “this approach is not always appropriate for numerous reasons,” the societies wrote. Aetna continues to require six weeks of conservative management before patients can consider a percutaneous vertebral augmentation procedure, a policy radiology groups believe is problematic.
“In summary, there is a large body of evidence which supports earlier interventional treatment for patients with [vertebral compression fractures],” the groups wrote. “Based on our review of the current body of literature, we ask that Aetna reconsider their decision to keep the requirement to provide six weeks of [nonsurgical management].”
Last year, the college estimated that at least six commercial insurers required at least four weeks of conversative management before percutaneous vertebral augmentation. The procedure involves injecting bone cement into a fractured vertebra through a small hole using imaging guidance. This restriction contradicts medical literature, along with Medicare payment policies in place since 2021, ACR et al. noted. Delaying surgical management in an often frail and elderly patient population can result in prolonged bed rest, immobility and the use of narcotics—potentially leading to decreasing physical conditions, poor pulmonary function and increased risk of death.
ACR reported about the ongoing advocacy campaign in a May 21 news update. The International Pain and Spine Intervention Society and North American Spine Society also signed the Tuesday letter to Robert McDonough, MD, executive director of clinical policy research and development at Aetna, which is part of the larger CVS Health Corp.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.