Radiologists call for ‘urgent’ update to payer policy they say is based on bogus info
Radiologists and other physician specialists are calling for “urgent” revision to a payer policy they say is based on bogus information.
The Society of Interventional Radiology and five additional doc groups recently voiced their displeasure in a letter to Elevance Health. In April, the payer formerly known as Anthem updated its guidelines for treating varicose veins.
With that, the insurer is no longer recommending endovenous cyanoacrylate closure, or CAC, a minimally invasive procedure that involves sealing off the impacted veins with medical-grade glue.
“After reviewing evidence from peer-reviewed medical literature, national physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas, the following procedures are not generally considered clinically appropriate and effective for the treatment of valvular incompetence (reflux) of the great or small saphenous veins and are not in accordance with generally accepted standards of medical practice,” Elevance Health’s new policy states.
However, the Society of Interventional Radiology, along with five other physician doc groups, now wants the Indianapolis-based payer to make “urgent, evidence-based revisions” to its policy. SIR, the American College of Cardiology, Society for Vascular Surgery and others said in a letter to Elevance that it is their “unanimous opinion” that cyanoacrylate closure is supported by medical evidence.
“Therefore, we respectfully request that CAC be promptly reconsidered and removed from the list of non-covered procedures in the Clinical [Utilization Management] Guideline,” Robert Lookstein, MD, president of the Society of Interventional Radiology, and physicians representing the ACC, SVS, the American Venous Forum, American Vein & Lymphatic Society, and the Society for Cardiovascular Angiography & Interventions wrote to the payer on June 4. “Following that removal, we further request that CAC be moved to the ‘Clinical Indications’ section and reclassified from ‘not medically necessary’ to ‘medically necessary,’” they added.
Literature recommending against this procedure “does not exist,” Lookstein and colleagues emphasized. The safety and efficacy of cyanoacrylate closure, in fact, has been “well established” through over a decade of peer-reviewed research and clinical experience. Other payers also endorse the procedure, they added, including UnitedHealthcare, which updated its policy to include CAC as a covered service effective July 1. Elevance Health and Aetna are the only two commercial payers in the country currently maintaining this stance.
Meanwhile, the physician societies’ position was “recently reinforced” by Carelon, another business unit of Elevance Health. The company develops clinical appropriateness guidelines used by health plans nationwide to determine what constitutes medically necessary care. In its recent guidance on the treatment of varicose veins, Carelon affirmed that both thermal and nonthermal ablation procedures (such as CAC) are appropriate for patients with symptomatic disease when certain criteria are met.
“Our six clinical societies respectfully urge Anthem to conduct an expedited review … and reconsider its position,” the letter concludes. “The current guideline is misaligned with the very sources it claims to follow—national specialty society recommendations and expert clinical opinion. Revising the guideline to allow coverage for CAC will support patient-centered, evidence-based care and empower physicians to offer the most appropriate treatment for each patient.”
The Society of Interventional Radiology also promoted the letter in a news update published June 20. In the same post, SIR highlighted another message sent to Humana May 12, asking the payer to modify its policy for peripheral nerve stimulation therapy.
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.