Evidence Guiding Commercial Payer Coverage Criteria for Total Ankle Arthroplasty.

Autor:	Kotlier JL; Keck School of Medicine of USC, Los Angeles, CA, USA., Fathi A; Keck School of Medicine of USC, Los Angeles, CA, USA., Ong MY; Keck School of Medicine of USC, Los Angeles, CA, USA., Yazditabar JM; Keck School of Medicine of USC, Los Angeles, CA, USA., Panoussi EE; Keck School of Medicine of USC, Los Angeles, CA, USA., Mayfield CK; Keck School of Medicine of USC, Los Angeles, CA, USA., Petrigliano FA; Keck School of Medicine of USC, Los Angeles, CA, USA., Liu JN; Keck School of Medicine of USC, Los Angeles, CA, USA., Peterson AB; Keck School of Medicine of USC, Los Angeles, CA, USA., Tan EW; Keck School of Medicine of USC, Los Angeles, CA, USA.
Jazyk:	angličtina
Zdroj:	Foot & ankle orthopaedics [Foot Ankle Orthop] 2024 Mar 24; Vol. 9 (1), pp. 24730114241239310. Date of Electronic Publication: 2024 Mar 24 (Print Publication: 2024).
DOI:	10.1177/24730114241239310
Abstrakt:	Background: Total ankle arthroplasty (TAA), first developed as an alternative to ankle arthrodesis, has become an increasingly popular management option for end-stage ankle arthritis. Prior studies have shown commercial insurance payers base their coverage criteria on limited and low level of evidence research. This study aims to quantify and describe the evidence insurance companies use to support TAA coverage policies. Methods: The top 11 national commercial health insurance payers for TAA were identified. A google search was performed to identify payer coverage policies. Policy documents were examined and cited references were classified by type of reference as well as reviewed for level of evidence (LOE). Specific coverage criteria for each individual payer were then extracted. Criteria were compared to assess for similarities among commercial payers. Finally, all references cited by each payer were examined to determine whether they mentioned the specific payer criteria. Results: Six of the 11 payers had accessible coverage policies. The majority of cited references were primary journal articles (145, 60.9%) and the majority of references cited (179, 75.2%) were level III or level IV evidence. We found significant homogeneity in coverage criteria among payers. In addition, cited sources inconsistently mentioned specific payer coverage criteria. Conclusion: This study demonstrates that commercial insurance payers rely on the relatively low level of currently available scientific evidence when formulating coverage policies for TAA use and adopt criteria that have not been thoroughly analyzed in the literature. More high level of evidence research is needed to help clinicians and insurance companies further refine indications for TAA so that patients who might benefit from the procedure are adequately covered. Level of Evidence: Level IV, review. Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online. (© The Author(s) 2024.)
Databáze:	MEDLINE
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