Radiology groups are slamming a recent coverage decision from industry giant UnitedHealthcare, saying it’s based on flawed information from “science-harvesting mercenaries.”
Four imaging societies shared their criticism in a recent letter to leaders at the commercial insurer. They’re concerned about coverage for basivertebral nerve ablation, a minimally invasive interventional procedure meant to help address lower back pain. Effective Jan. 1, UHC has labeled the treatment as “unproven and not medically necessary due to insufficient evidence of efficacy.”
“Well-designed, randomized controlled trials with large sample sizes and long-term follow-up are needed to establish the impact on health outcomes,” UnitedHealthcare said in its recent coverage decision document.
Medical societies including the American College of Radiology and Society of Interventional Radiology bristled at this assertion. Basivertebral nerve ablation has already been in use by radiologists and other physicians for nine years and is backed by evidence. They questioned UHC’s reliance on an “infamous” third-party literature review from Hayes Inc.
“We believe that the volitional mischaracterization of straightforward data by ‘science-harvesting mercenaries’ has led to inappropriate denial of care to UnitedHealthcare’s members,” ACR, SIR, the American Society of Neuroradiology and the American Society of Spine Radiology wrote in their March 21 letter. “The likely outcome will be higher costs and risks for the subset of treatable patients.”
UHC could not provide comment on the letter by late Wednesday. ACR et al. are asking the payer to join them—alongside all Medicare Administrative Contractors and more than 20 other insurance carriers—in covering the appropriate use of basivertebral nerve ablation.
“After reviewing the above comments, it is hoped that UnitedHealthcare will consider revising these policy changes to reflect the new evidence and provide coverage accordingly,” the letter concluded.
Others signing the letter included the American Academy of Physical Medicine & Rehabilitation, the American Society of Regional Anesthesia & Pain Medicine, and the North American Spine Society, altogether representing over 47,000 members.
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.