UnitedHealthcare's updated coverage policy is 'disappointing,' devicemaker says

Nevro, a company that sells chronic pain medical devices, called UnitedHealthcare's newest coverage policy update "disappointing" after the insurance company hinted it wouldn't cover spinal cord stimulation devices for some people with chronic back pain. 

In a revised coverage policy that will be effective Dec. 1, UnitedHealthcare wrote that implanted spinal cord stimulators, which are intended to treat chronic intractable back pain without prior spine surgery, are "not medically necessary" because of "insufficient evidence of efficacy."

"Although this update is disappointing, there were United [non specific back pain] cases getting approved (and denied) before this change, and that will continue to be the case moving forward on an individual patient basis depending on a patient's unique clinical history and medical necessity," Keith Grossman, the CEO and president of Redwood City, Calif.-based Nevro, said in an Oct. 10 statement. 

Nevro said UnitedHealthcare did not previously have a coverage policy for nonspecific back pain patients, and the news will affect its 2023 revenues between "low to mid-single digit millions of dollars."

"We regularly review new clinical evidence and update our medical policies to ensure they reflect the most current published evidence-based medicine," a UnitedHealthcare spokesperson told Becker's. "Depending on the specific coverage determination and the terms of the member's benefit plan, providers and members may have the right to appeal, providing information to support the requested treatment."

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