Insurance Advocacy by Boston Scientific:
Patient Access Program
Once a physician has determined that the Intracept™ Procedure is the best treatment to address a patient’s chronic low back pain, obtaining prior authorization and approval for payment from the patient’s insurance company may require multiple steps:
- Prior Authorization
- Internal Appeal(s)
- External Appeal
The goal of Intracept’s patient access program is to assist patients in navigating that process.
The Steps Involved
Prior Authorization:
Patients sign a consent form to enter the program, allowing an Boston Scientific representative to continuously work on their behalf to obtain authorization for the Intracept™ Procedure. Your physician will provide the clinical documentation that demonstrates medical necessity to submit to the patient’s insurance company.
If the insurance company provides approval (prior authorization), the Boston Scientific representative will contact the patient and physician to inform them of the authorization.
Internal Appeal:
If the insurance company does not approve the prior authorization request, Boston Scientific will assist in submitting appeal letters and additional materials to support medical necessity. If the insurance company provides approval, the procedure can be scheduled.
External Appeal:
If the insurance company does not approve the procedure after internal appeal(s), patients may have the right to request an external review with an Independent Review Organization (IRO). The Boston Scientific team will assist patients throughout this process.
As part of the process, we educate insurance companies on the patient benefits and clinical significance of the Intracept™ Procedure with the ultimate goal of establishing positive coverage policies for it.
Our Goal
Get the right documentation:
Obtain the necessary documents that must be submitted in an attempt to obtain approval for the Intracept™ Procedure.
Keep things on track:
During the appeals process, Boston Scientific will assist with insurance company interactions. We will monitor the timeliness of the insurance company’s response. If a deadline passes without a response, you may lose your right to appeal your insurance company’s decision.
Educate all parties:
As part of the process, we educate insurance companies on the patient benefits and clinical significance of the Intracept™ Procedure with the ultimate goal of establishing positive coverage policies for it.
The Intracept™ Procedure is supported with Level l clinical evidence, has 510(k) Clearance, and is commercially available in the United States. For more information on the patient access program, please contact Boston Scientific reimbursement team at reimbursement@relievant.com.
Boston Scientific is pleased to provide general information on coding, coverage and payment. This information is not intended to be legal or financial advice. Nothing stated above should be construed as a guarantee by Boston Scientific of coverage or payment for Intracept™ Procedures. Nothing should be viewed as an instruction to use a particular code or influence levels of payment. Providers are responsible for exercising their independent clinical judgment and reporting the codes that accurately reflect the patient’s condition and the services rendered and submit bills consistent with the patient’s insurer’s requirements. Reimbursement changes annually. This information is accurate as of January 1, 2022. Providers are advised to consult with the applicable payer or the specialty society or legal counsel for any coding, payment or billing related issues.