Radiology societies implore Cigna to reverse decision cutting off access to ‘critically important’ service
Radiology societies are imploring health insurer Cigna to reverse a recent coverage decision that cuts off patient access to a “critically important” service.
The American Society of Neuroradiology and Society of Interventional Radiology made their case in a June 25 letter to the Connecticut-based payer. They’re concerned about Cigna’s refusal to reimburse for peripheral nerve stimulation, used to treat chronic pain.
In March, the insurer ruled that the procedure lacks medical necessity. However, radiologists and other physicians charge that this decision is “incongruent with the extensive body of evidence supporting its efficacy.” Peripheral nerve stimulation has a proven track record for treating chronic pain conditions including intractable knee, shoulder and back pain where treatment options are limited, physicians noted.
“Peripheral nerve stimulation consistently results in improvement in pain, reduced disability, lower opioid use and improvement in quality of life for people affected by chronic pain,” societies representing radiologists, anesthesiologists, neurologists, urologists and other specialists wrote to Cigna Senior Medical Director Michelle Gabbert, DO. “By dismissing [peripheral nerve stimulation] as ‘not medically necessary,’ Cigna denies patients access to a treatment modality that has been recommended in treatment guidelines created by physician societies.”
Altogether, the letter writers represent over 88,000 physicians from across the U.S. They included a list of 40-plus studies supporting their position while underlining the “urgent need” to revise payment Policy No. 0539. They highlighted several other indications for peripheral nerve stimulation with strong evidence, among them, neuropathic pain in the upper and lower extremities and phantom limb pain following an amputation.
“We stand ready to provide any additional information or support to facilitate reconsideration of Cigna’s denial of access to critically important therapies for patients with intractable chronic pain,” the letter concluded. “Ensuring access to effective pain management treatments is essential for improving the quality of life for individuals suffering from chronic pain.”
Others signing the message included the American Academy of Physical Medicine and Rehabilitation, the American Association of Neurological Surgeons, the American Society of Anesthesiologists, the Congress of Neurological Surgeons, the North American Neuromodulation Society, and the North American Spine Society.
Many of the same groups wrote a similar letter a year ago, voicing concern about BlueCross BlueShield of Tennessee’s refusal to cover peripheral nerve stimulation devices.
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.