Aetna didn't change its payment policy for treating fractured vertebrae despite the urging of spine and radiology groups.
A May 2023 letter cosigned by groups including North American Spine Society, American Society of Spine Radiology and the American College of Radiology asked Aetna to cover percutaneous vertebral augmentation for compression fractures in the vertebral body in the initial days after an injury.
Aetna's policy requires six weeks of conservative management before considering it. And the insurer's May 15 review kept the policy unchanged, Radiology Business reported May 22.
The American College of Radiology in a May 21 statement challenged Aetna's position and said "the medical societies contend these requirements should be revised/eliminated as they can potentially negatively impact patient outcomes and providers' ability to deliver evidence-based, appropriate spinal care to all patients."
Aetna in a May 22 statement to Becker's said clinical policy bulletins are "statements of policy regarding the medical necessity, and experimental and investigational status, of medical technologies and treatments that may be eligible for coverage under our medical plans."
"The Aetna Clinical Policy Bulletin Back Pain – Invasive Procedures details our criteria for vertebroplasty and kyphoplasty, which requires six weeks of conservative treatment when the collapse/compression vertebral fracture is due to osteoporosis or steroid-induced osteopenia," the statement said. "This is consistent with placebo-controlled randomized studies that have failed to demonstrate benefits over time and also with industry standards. The requirement does not apply to conditions that are not expected to improve over four to six weeks."