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Insurance Coverage

We work with providers that participate in all insurance programs – contact us now to determine if you qualify for a bone growth stimulator.

Our team of insurance experts knows how to work with your insurance company to get your bone growth stimulator approved. We have in-network access to hundreds of insurance companies and thousands of plans. We work with companies such as: Aetna, Anthem, Blue Cross/Blue Shield, Cigna, Humana, Medical Mutual, Tri-Care, Worker’s Compensation, United Health Care, and many more throughout the US.

Coverage for a bone growth stimulator varies by insurance carrier. Two x-rays taken 90 days apart showing insufficient healing are generally required for insurance approval. Worker’s comp patients can generally be covered without waiting 90 days.

Bone Stimulator Insurance Commercial Coverage

To determine the cost of bone growth stimulators, review your specific insurance and verify what documentation you must provide to receive bone growth stimulator coverage. Depending on your insurance provider, the guidelines for determining whether a bone growth stimulation device is covered will differ. For instance, for individuals covered by Anthem BlueCross, the following conditions must be met before they will cover an electrical bone growth stimulator: at least 45 days have passed since the date of fracture or the date of surgical treatment of the fracture; serial radiographs or appropriate imaging studies were performed to confirm that no progressive signs of healing have occurred; and the fracture gap is less than 1 centimeter [3]. 

In order for these conditions to be officially met, you must provide documentation to your insurance provider. For example, if electrical or electromagnetic bone growth stimulation is required and the insurance provider is United Healthcare, you need to provide official medical notes documenting all of the following: 1) current physician prescription or order; 2) the reason a bone growth stimulator is needed; 3) any risk factors that apply (such as obesity or smoking) [4]. These requirements vary slightly from insurance provider to insurance provider and depend on the type of bone growth stimulant sought (electrical bone growth stimulator, ultrasonic bone growth stimulator, or electromagnetic bone growth stimulator).  You can learn more about general insurance criteria for coverage for several providers here, including medicare guidelines for bone growth stimulators. Determining your health insurance coverage is essential in order to estimate bone stimulator costs.

All of the documentation requirements to gain approval for bone growth stimulators are already set by your insurance company. Most are available on the insurance company’s website. However, we are here to help. We work with health care providers that participate in all insurance programs to determine your documentation needs. Contact us today to determine if you qualify for a bone growth stimulator. 

Coverage criteria for bone growth stimulators

Your  health insurance company may help cover the cost of a bone growth stimulation device. The first step is to determine the coverage criteria for your particular insurance company. You also have to decide which type of bone growth stimulator you are interested in as the type of bone growth stimulator will also affect criteria for insurance. Your insurance provider will also require documents providing proof of non-healing (usually 45 to 90 days of time) in order to qualify for coverage of a bone growth stimulator device. 

For example, if electrical or electromagnetic bone growth stimulation is sought and the insurance provider is United Healthcare, the fracture must have 90 days of non-healing (nonunion) and you must provide official medical notes documenting all of the following: 1) current physician prescription; 2) documentation explaining the reason a bone growth stimulator is needed; 3) any risk factors that apply (such as obesity or smoking). Additionally, your insurance company will need medical office notes documenting: 1) date, site and type of fracture; 2) diagnostic imaging reports; 3) treatment of the fracture, including treatment already completed and treatment planned [5].

Patient pay and insurance estimates

The out of pocket cost for a bone growth stimulator depends on your insurance provider. For individuals receiving Medicare benefits, the cost you will have to cover is generally 20% of the Medicare allowable amount. It is important to know that this technology is expensive, and the price of a bone growth stimulation unit can range from $500 to $5,000. Contact your insurance provider today to determine your exact patient pay and insurance estimates.

Financing options

Many companies offer financing options for your bone growth stimulation costs. According to Orthofix’s website, customer service representatives will work with you to establish a payment plan. Orthofix  uses established guidelines to assess your eligibility for a financial hardship waiver or reduction of the amount owed.

Medicare Guidelines for Bone Stimulators

Bone Growth Stimulators

Bone growth stimulation is a treatment that promotes the healing of fractures, particularly nonunion fractures. These devices work by administering either electrical, electromagnetic, or ultrasonic pulses to the fractured area and promote bone healing. While there are many risk factors for developing a nonunion fracture (that requires bone growth stimulator treatment), one important risk factor is age [6]. 

Medicare coverage policies

Medicare and Medicare Part B plans require that several criteria be met for coverage of a bone growth stimulator for a nonunion fracture. According to Medicare coverage policies:

“Fracture nonunion is considered to exist only when serial radiographs have confirmed that fracture healing has ceased for three or more months prior to starting treatment with the electrical OSTEOGENIC STIMULATOR. Serial radiographs must include a minimum of two sets of radiographs, each including multiple views of the fracture site, separated by a minimum of 90 days.” [7]

Once qualification is met to receive a bone growth stimulator, understand the associated costs. For individuals receiving Medicare benefits, the cost you will have to cover is generally 20% of the Medicare allowable amount. However, this technology is expensive, and the price of a bone growth stimulation unit can range from $500 to $5,000. This means that your out of pocket copay may be as high as $1,000.

The good news is that some bone growth stimulator companies offer payment plans and other financial services to help you cover the out of pocket costs of your bone growth stimulator. At Orthofix, customer service representatives will work with you to establish a payment plan or use their established guidelines to assess your eligibility for a financial hardship waiver or reduction of the amount owed [8].

If you still have question about bone stimulator coverage under Medicare we are here to help. We work directly with health care providers that participate in all insurance programs to determine your documentation needs. Contact us today to submit your insurance information and determine if you qualify for a bone growth stimulator coverage.

Summary

If you are in need of a bone growth stimulation device, it is important to determine what role your insurance company will play. To determine which devices are covered by your insurance and what your out of pocket costs are, we work with directly with health care providers that participate in all insurance programs. We can help you resolve your documentation needs. Contact us today to submit your insurance information and determine if you qualify for a bone growth stimulator. 

References

[1] Zura R, Mehta S, Della Rocca GJ, Steen RG. Biological risk factors for nonunion of bone fracture. JBJS reviews. 2016 Jan 5;4(1).

[2] Ultrasound Bone Growth Stimulation. 2020. Accessed 8/25/2020. www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_d083855.html

[3] Noninvasive Electrical Bone Growth Stimulation of the Appendicular Skeleton. 2019. Accessed 8/25/2020. www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_d055254.html

[4] Electrical and Ultrasound Bone Growth Stimulators. 2020. Accessed 8/25/2020. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/electrical-ultrasound-bone-growth-stimulators.df

[5] Electrical and Ultrasound Bone Growth Stimulators. 2020. Accessed 8/30/2020. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/electrical-ultrasound-bone-growth-stimulators.pdf

[6] Zura R, Mehta S, Della Rocca GJ, Steen RG. Biological risk factors for nonunion of bone fracture. JBJS reviews. 2016;4(1).

[7] Decision Memo for Electrical Stimulation for Fracture Healing (CAG-00043N). 1999. Accessed 8/30/2020. https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=24&NcaName=Electrical+Stimulation+for+Fracture+Healing

[8] Patient Guide to Insurance Coverage for Bone Growth Therapy. 2016. Accessed 8/30/2020. http://bonegrowththerapy.com/media/1156/bs-1612-astro-insurance-coverage-dfnl.pdf 

 
Insurance Covered Summary of Medical Policy Medical Policy
Aetna Yes Yes for certain fresh fractures and delayed unions View
Anthem Yes Yes with 45 days of no significant healing View
Cigna Yes Yes with 90 days of no significant healing View
Blue Cross Blue Shield of West Virginia Yes Covered with 3 months of no significant healing View
Medicare Yes Yes with 90 days of no significant healing View
Medicaid Limited Depends on state policy.
United Healthcare Commercial Yes Yes with 90 days of no signs of healing View
Highmark Yes Covered with 3 months of no significant healing View
United Healthcare Medicare Advantage Yes Follows Medicare guidelines View
Blue Cross Blue Shield of North Carolina Yes Covered with 3 months of no significant healing View
Excellus BCBS Yes Covered for non-union fractures with 90 days of no progressive healing. View