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ISIS Secures a Non-Coverage Policy Reversal

Posted By Administration, Monday, July 16, 2012

As shared with ISIS members in previous e-news articles, ISIS was alerted that payers were misapplying the findings of the Washington State Health Technology Assessment of spinal injection and implementing non-coverage policies for procedures that should have been covered.

Dr. Paul Dreyfuss, on behalf of ISIS, met with several Medical Directors of Regence BCBS to address Uniform Medical's non-coverage policy on facet joint interventions and explain ISIS' concerns and positions. Mutual understanding was reached in the meeting. On June 29, 2012 Regence’s Vice President of Provider Services sent out a letter to providers announcing the reversal of a non-coverage policy:

"Effective immediately, Therapeutic Cervical, Thoracic and Lumbar Epidural Injections and Sacroiliac Joint Injections are a covered benefit for the treatment of chronic pain.”

To review the full letter, please click here.

As ISIS continues to work to address these issues, we ask that our members remain vigilant and contact ISIS immediately at if any payer, anywhere in the country, cites the WA State HTA Findings and Coverage Report to support an inappropriately restrictive coverage decision. It is crucial that the WA State HTA Coverage Report be appropriately interpreted when used by payers nationwide.

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