Support
Insurance Coverage and Reimbursement for iFuse
Coverage
Will Your Insurance Cover iFuse?
Will Your Insurance Cover iFuse?
This is a common question for patients and providers alike. Minimally invasive surgical fusion of the SI joint is not universally covered by insurance companies. The good news is, more and more are adding it as time goes on. The best way to find out is to call your insurance company and ask if they provide a Positive Coverage Policy for iFuse Implant System®.
Prior Authorization: Some insurance companies require prior authorization before they cover iFuse. Prior authorization involves the surgeon making a request for coverage to an insurance company.
The surgeon describes the nature of the patient’s condition and why it is necessary to perform the iFuse procedure. The insurance company reviews the request and makes a determination as to whether it will be covered under the patient’s insurance plan.
Insurance Appeals: When patients are forced to appeal their insurance denials while struggling with SI joint pain, the experience can be overwhelming. We would like to help.
If you are a patient who has experienced an insurance denial, or have been denied access to the iFuse procedure through your commercial or Medicare plan, we have resources for you.
Appeals
Insurance Appeals Resources
Insurance Appeals Resources
The following insurance support resources are downloadable and printable, and are designed to help facilitate the insurance authorization and appeals process.
Resources
Patient Insurance Authorization Workbook - This workbook is designed to help you navigate the insurance authorization process for your iFuse Procedure.
ISASS Policy 2016 Update: Minimally Invasive Sacroiliac Joint Fusion - Coverage policy of the International Society for the Advancement of Spine Surgery (ISASS) for Minimally Invasive Sacroiliac Joint Fusion, originally published in 2014 and later updated July 2016.
Support Authorization
Before any assistance can be provided, SI-BONE must receive signed authorization from the patient (or the patient’s parent/guardian).
- Patient Insurance Authorization Form (PDF) - download, complete, and send, or
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Online Authorization Form - complete and submit
In connection with its ongoing efforts to facilitate patient access to its technologies by providing education and training to healthcare professionals, SI-BONE Inc. provides certain assistance designed to help you obtain patient coverage decisions from third party payors.
You may be eligible for support if you are:
- Pre- or post-operative iFuse patients who have been denied access to treatment or those who are currently involved in the appeal process
- Post-opertive patients whose insurance was denied after receiving the iFuse procedure
- Medicare or disabled patients who were denied treatment
- Patients who exhausted the appeal process, (final denial, external review or ALJ) and are interested in appealing their case using the newest published clinical evidence
SI-BONE PICS Responsibilities
Here are some of the ways SI-BONE can help you with your insurance approvals and appeals process:
- Facilitating appeal assistance - contacting insurance office, confirming details such as deadlines, receipt of appeal letters and requests etc.
- Patient appeal education-providing guidance and support
- Record keeping/reporting
- Following processes while keeping the patient informed
- Making the patient aware of the latest clinical research supporting the iFuse Implant System®
Positive coverage
Positive Insurance Coverage Policies for iFuse
Positive Insurance Coverage Policies for iFuse
- Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas
- Blue Cross Blue Shield of Michigan
- Blue Cross Blue Shield of Nebraska
- Blue Cross and Blue Shield of Vermont
- Cahaba
- CGS Administrators, LLC
- First Coast Service Options, Inc. (FCSO)
- Geisinger Health Plan
- Health Care Service Corporation (HCSC)
- Highmark, IncHighmark, Inc
- National Government Services, Inc.
- U.S. Military's TRICARE
- Utah’s Public Employees Health Plan (PEHP)
This list is not comprehensive, so if you don't see your insurance carrier, please call them. Also ask your insurance carrier whether your policy covers minimally invasive sacroiliac joint surgery.
Support
Patient Insurance Coverage Support (PICS)
If you are a patient experiencing an insurance denial, and are interested in Patient Insurance Coverage Support (PICS), please contact us today.