Advocacy Call to Action
Response to Anthem Health Insurance
Background
The Anthem Office of Medical Policy & Technology Assessment (OMPTA) has recently drafted a policy and position statement regarding the medical necessity of the use of an internal rib fixation system, specifically a new policy titled SURG.00120. This position statement includes the following:
The use of an internal rib fixation system is considered investigational and not medically necessary for all indications.
Anthem Health Insurance is the largest for-profit managed health care company in the Blue Cross and Blue Shield Association. They insure 40 million Americans (approximately 12.3% of the total population) - and given that they are part of the "Blues" insurance family, a change in procedure coverage by one could indicate a change for many, if not all - and could serve as a harbinger for other third-party payers.
CWIS Response
The Chest Wall Injury Society is expressly opposed to this belief, and has taken the opportunity to state our position, as the Anthem OMPTA is currently seeking input from societies and individual board-certified physicians on this topic and newly proposed policy.
On behalf of the Chest Wall Injury Society and its members, and with the support of the Executive Committee, the Medical Policy Questionnaire and a formal letter of response were sent in response on Saturday, August 11, 2018.
Copies of these documents are available for review to the right.
Call to Action
In addition to the collective voice of the society, we wanted to share this information with you in case you desire to send an individual response. We encourage you to use the citations included in the formal response provided, as well as any others you have written or are aware of from your personal reading.
Additionally, we know that stories can connect us with ideas and bond people - so it might be worth considering including one or more of your most compelling patient success stories that help demonstrate the impact of SSRF on individual patients. Let's remind Anthem that some of their 40 million insured lives represent people who might suffer the perils of chest wall injury and benefit from your knowledge, skills, and talent. We would appreciate them trusting you to determine who might be a surgical candidate, rather than limiting patient care through short-sighted reimbursement policies.
Due to limitations in this web platform, the required Word document template for policy feedback cannot be posted. If you would like to participate in this opportunity for feedback, please contact SarahAnn Whitbeck via email (sarahann@cwisociety.org) or text (801/910-3241).
Please note: As a response has already been sent on behalf of CWIS, please indicate you are responding on behalf of yourself - option 1 on the form.
Responses are due on or before August 24, 2018 and should be emailed to Ms. Barbara Brown via Technology.Compendium@Anthem.com.
If you have any questions or need assistance, please contact us via information@cwisociety.org or call (801) 910-3241.