If your doctor says a certain drug or therapy would be beneficial in treating you, your insurance company still needs to agree to pay for it. This can be frustrating for patients and practitioners when they are trying to improve a chronic condition such as GERD or LPR.
In order for an insurance company to change their coverage policies, they need to be presented with certain information to convince them that the procedure is safe, reliable, and effective, both medically and in terms of cost. This takes legitimate peer-reviewed, published clinical studies incorporating hundreds or thousands of patients and a lot of effort and organization to present the right information to the right people, such as the insurance companies’ medical directors and clinical coding teams.
Since Restech’s acquisition of Mederi Therapeutics in 2018, getting expanded coverage has been one of our biggest areas of focus, and one of our biggest challenges. With the help of our physician users and their patients, Restech has managed to make some progress and gain positive coverage determinations from key insurance companies in the US.
Most recently, millions of patients with Palmetto GBA Medicare in Alabama, Georgia, Tennessee, South Carolina, North Carolina, Virginia, and West Virginia have gained access to the procedure. In addition, First Coast Service Options Inc provided a similar change in coverage determination for Medicare patients in Florida, Puerto Rico, and the US Virgin Islands.
Palmetto GBA and First Coast Service Options Inc join longstanding Medicare providers including Novitas, in offering the Stretta procedure. Private payers such as CareFirst Blue Cross Blue Shield (Maryland and the District of Columbia) and Highmark Blue Cross Blue Shield (Delaware, Pennsylvania, and West Virginia) were recently augmented by Blue Cross and Blue Shield of North Dakota. Veterans Administration patients nationwide have long had access to the Stretta Procedure.
Debra Krahel, President and CEO of Restech commented, “These coverage determinations are the culmination of hard work from our team, our physicians, and the thousands of patients requesting a minimally invasive approach to reflux. Stretta provides a safe, effective alternative to medication and anatomy altering surgery with an impressive history of clinical documentation – we are gratified that insurance providers are responding to patient and physician demand.”
For further information about Stretta coverage, please contact our team at 1-800-352-1512 or write to us at firstname.lastname@example.org.