Some BCBS of Michigan knee arthritis patients faced $450-$1k in out-of-pocket costs, until insurer backpedaled plan

Blue Cross Blue Shield of Michigan upended its decision to not pay for some anti-arthritis injections, according to the Detroit Free Press.

The insurer notified providers in late March it will continue covering hyaluronic acid injections, or viscosupplementation therapy. The decision comes after BCBSM told providers in January it would end payments for the injections April 1 due to controversy over the treatment's efficacy.

"There is great controversy regarding the effectiveness of this treatment nationally," Blue Cross spokesperson Helen Stojic told the Detroit Free Press. "Many health plans — including some in Michigan — have opted to no longer pay for the injections. We are in the process of communicating to our members who are using the treatment to let them know about the ongoing review."

Physicians disagree over the effectiveness of the anti-arthritis injections. After a review of several patient studies, the American Academy of Orthopedic Surgeons stopped recommending hyaluronic acid injections for knees in 2013. In another study of 86,000-plus Humana members, researchers found the injections may waste million of dollars as patients end up undergoing joint replacement procedures anyway.

However, patient advocates and orthopedic physicians pushed back against BCBSM's wariness. Members of the Michigan Orthopedics Society argued the injections may help arthritis patients reduce pain and postpone knee replacements, according to the report.

Had BCBSM pursued its policy change, patients seeking the shots would have faced anywhere from $450 to $1,000 in out-of-pocket costs.

BCBSM will continue to review information about the injections. It hasn't said when a final coverage decision will be made, the report states.

More articles on payer issues:
Survey: Majority of Americans believe ACA marketplaces are 'collapsing'
CMS axes Medicare Advantage star rating measure: 5 things to know
Insurer payments to climb 3.4% under new Medicare Advantage rule: 3 notes

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Top 40 articles from the past 6 months