Variations in lumbar spinal surgery insurance coverage for degenerative spinal disease

Abstract

Introduction: Lumbar fusion is selectively restricted for patients based on insurance policies which can vary widely between companies, potentially complicating patient care. This paper aims to analyze current insurance coverage for lumbar fusion for degenerative spine conditions among US insurance companies.

Methods: A cross-sectional analysis was conducted of US insurance coverage policies from December 2020 to February 2021 for lumbar fusion. Policies were analyzed for coverage criteria and stratified based on degenerative spinal disease process. Insurance companies were selected based on their state enrollment data and market share. Chi-squared and Fisher exact tests were applied to identify differences between groups.

Results: Of the 58 insurers, 73 ​% provided coverage for lumbar spinal fusion and there was significant difference in coverage for degenerative spinal disease (p ​< ​0.01). Among the policies queried, there was a significant difference in the proportion of insurers requiring documentation of disease severity (p ​= ​0.01191).

Conclusion: Policy criteria for lumbar fusion surgery vary greatly between insurance companies and often deviate from North American Spine Society care recommendations.