Insurance Coverage and Reimbursement for iFuse

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.

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
  
• 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