Radiology groups express ‘profound objection’ to Humana labeling interventional service as ‘unproven’

Radiology groups are expressing “profound objection” after insurer Humana has refused to cover a key interventional procedure.

Specialists shared their concern after the Louisville, Kentucky-based payer classified closed-loop spinal cord stimulation as “experimental, investigational, and/or unproven.” Such technology is an “evolutionary” approach to pain management, with the device actively monitoring the spinal cord’s response to electrical stimulation and automatically adjusts. 

Previous studies in reputable medical journals have demonstrated substantial improvement among those suffering from back and leg pain three years after treatment. Humana Medicare Advantage recently reclassified closed-loop spinal cord stimulation as a covered service. Yet, the insurer’s commercial plans still view it as unproven, the Society of Interventional Radiology and others noted. 

“We express our profound objection to the current characterization by your commercial coverage policy of closed-loop spinal cord stimulation therapy as experimental, as it is our firm belief that such a classification does a disservice to patients and neglects the scientific research, rigorous clinical trials, and evidence supporting the efficacy of closed-loop SCS therapy,” groups representing over 95,000 healthcare professionals—also including pain physicians, neurosurgeons, orthopedic surgeons and physiatrists—wrote to Humana’s associate VP of physician leadership on Oct. 9. 

Closed-loop SCS also has allowed a significant number of patients to taper off opioid therapy, “underscoring its effectiveness and impact on public health.” Federal payers have acknowledged the technology’s effectiveness, with CMS granting its transitional pass-through designation. This has enabled temporary enhanced reimbursement due to the therapy meeting the requirement of demonstrating “substantial clinical improvement,” the groups noted. 

“This recognizes the therapy’s ability to significantly enhance clinical outcomes for patients, reaffirming its status as a groundbreaking and validated therapeutic option,” they wrote. 

Plus, closed-loop spinal cord stimulation therapy has been shown to be “at least as good, if not better than” the alternative open-loop SCS. Such treatment has been in use for over 40 years and proven as superior to repeat spinal surgery or other approaches. 

“In light of this compelling body of evidence, we strongly suggest you reconsider your current coverage policy for closed-loop devices,” the groups wrote to Manisha Dhuria, MD, MBA. “The scientific community at large recognizes closed-loop SCS as an evolutionary and proven advancement, offering patients a level of personalized care that was once unimaginable. Dismissing it as ‘experimental, investigational, and/or unproven’ not only undermines the years of dedicated research but also restricts patient access to a treatment that has the potential to transform lives.”

Others signing the message included the American Society of Neuroradiology, American Society of Spine Radiology, American Academy of Physical Medicine and Rehabilitation, American Association of Neurological Surgeons, American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, Congress of Neurological Surgeons, International Pain and Spine Intervention Society, North American Neuromodulation Society, and the North American Spine Society. You can read the full letter here.