The Blue Cross Blue Shield Association and several associated member plans are facing a lawsuit over an alleged scheme to exclude spinal fusion technology from TranS1 from coverage.
The devicemaker filed the lawsuit March 17 in U.S. district court for the Eastern District of Pennsylvania and alleges that BCBSA’s member plans collectively refused to cover the AxialLIF, which is used for a single-level lumbar spinal fusion. According to the lawsuit, the insurer claimed that AxialLIF is experimental and investigational, which isn’t the case, TranS1 said.
The insurer refused to cover the system because its efficacy for a wider patient base could increase demand for spinal fusions, according to the lawsuit.
“That in turn would drive up patient demand, the total number of spinal fusions performed and Defendants’ reimbursement obligations,” the lawsuit reads. “Defendants have colluded to shut AxiaLIF out of the market to suppress that demand and their reimbursement obligations in turn.”
The devicemaker is seeking damages and an injunction against the agreements alleged in the lawsuit.
A spokesperson for Blue Cross Blue Shield Association told Becker’s that the insurer does not comment on active litigation.
