Insurance Coverage – X-Stop Spacer
The X-Stop® Spacer is a device that is implanted between the interspinous processes of the spine during a minimally invasive procedure. The X-Stop Spacer limits pathological extension of the treated spinal segments and maintains them in a neutral, or slightly flexed, position.
The goal is to reduce the symptoms of lumbar spinal stenosis (LSS) in patients who have undergone conservative treatment for at least 6 months prior.
The procedure is covered by Medicare and select private payers. Private payers typically require you or your doctor to submit paperwork for pre-authorization of an elective surgery.
Your insurance may approve or deny the decision to cover the procedure. If the request is denied, the insurance carrier is required to provide you with the necessary information so that you can request a review and reconsideration if your claim is denied.
The insurance payer is obligated to give you the requisite forms (if any) and instructions regarding the appeal process. By completing each step of the appeal process and providing the right information according to the insurance company’s policies and procedures, policy holders may overturn a denial.
If you choose to appeal with your health insurance plan, it is important that you and/or your doctor communicate clearly and provide medical documentation supporting medical necessity for the procedure.
It is also helpful to provide clinical articles or medical documents supporting the clinical benefits of the procedure. As a final note, keep a log and maintain accurate records of your interactions with the insurance company.
Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.
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