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BackTable / VI / Podcast / Episode #368

The Recent Trend of Insurance Denials for CLI Interventions

with Dr. Bret Wiechmann

In this episode, host Dr. Aaron Fritts and Dr. Krishna Mannava engage in a discussion with Dr. Bret Wiechmann about a concerning trend in the field—insurance denials for critical limb ischemia (CLI) interventions.

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The Recent Trend of Insurance Denials for CLI Interventions with Dr. Bret Wiechmann on the BackTable VI Podcast)
Ep 368 The Recent Trend of Insurance Denials for CLI Interventions with Dr. Bret Wiechmann
00:00 / 01:04

BackTable, LLC (Producer). (2023, September 25). Ep. 368 – The Recent Trend of Insurance Denials for CLI Interventions [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Bret Wiechmann discusses The Recent Trend of Insurance Denials for CLI Interventions on the BackTable 368 Podcast

Dr. Bret Wiechmann

Dr. Bret Wiechmann is an interventional radiologist and the medical director of Vascular & Interventional Physicians in Gainesville, Florida.

Dr. Krishna Mannava discusses The Recent Trend of Insurance Denials for CLI Interventions on the BackTable 368 Podcast

Dr. Krishna Mannava

Dr. Krishna Mannava is a vascular surgeon and medical director at Vive Vascular in Columbus, Ohio.

Dr. Aaron Fritts discusses The Recent Trend of Insurance Denials for CLI Interventions on the BackTable 368 Podcast

Dr. Aaron Fritts

Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.

Synopsis

Bret is an IR in Gainesville, Florida with over 26 years of experience and is one of the founders of the Outpatient Endovascular & Interventional Society (OEIS). OEIS was started 10 years ago to advocate for the viability of non-hospital IR services.

We start the episode with Bret sharing his staff’s firsthand encounters with pre-authorization challenges for atherectomy procedures.The panel discusses how the recent inflammatory NY Times article regarding the use of atherectomy to treat peripheral artery disease has exacerbated these challenges. The doctors delve into the perplexing use of non-scientific articles as evidence by insurance companies, which are often influenced by third-party recommendations. The disconnect between insurance decisions and patients' actual needs becomes evident, as peer-to-peer reviews usually involve physicians unfamiliar with the specific medical speciality.

Next, we explore strategies for navigating the intricacies of insurance approvals, a particularly challenging task as each insurance company has its unique set of requirements for procedure coverage. Evaluating these requirements for each patient not only limits the capabilities of the physician, but also decreases the quality of the patient's care. One strategy that is discussed is compiling a list of different payers and their specific requirements for each procedure, but this takes away valuable time away from a patient’s care. Another strategy includes the intriguing notion of physicians noting the names of insurance companies and peer reviewers on medical records as reasons for denying certain procedures. While promising, the effectiveness of this approach remains uncertain. Furthermore, the episode contemplates the possibility of refusing to work with insurance companies that consistently denying coverage— a bold strategy that warrants careful consideration as it may drop patient volumes.

To combat the rising tide of insurance denials, the discussion emphasizes the pivotal role played by organizations like OEIS. It highlights the importance of involving referring physicians in various specialties, patients themselves as well as industry stakeholders manufacturing relevant devices to bring about meaningful change in the insurance approval process.

Resources

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Topics

Atherectomy Procedure Prep
Critical Limb Ischemia (CLI) Condition Overview
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