Question: Denied Kyphoplasty surgery by insurance; what is the next step?

I am a 55 year old female who has comp. fractures at T7 and T8. My insurance company denied me kyphoplasty surgery, stating there has not been enough clinical data to support its success and Medicare is the only insurance to date that has paid my doctor to perform this procedure.

Do you have any information to prove the success of this procedure and can you provide me with the names of any insurance company that has paid for this procedure other than Medicare? I am 12 wks into the fracture, so time if of the essence. Thank you.

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Doctor’s response: Contact Kyphon

I do not have the references off-hand, but there are multiple articles that support kyphoplasty, as an effective treatment for a compression fracture. I have been paid by three different insurance companies for the procedure, although in my state (Wisconsin), Medicare does not actually pay for the procedure.

Contact Kyphon, the company that makes the kyphoplasty device. They would have a list of the articles and can probably help you with reimbursement issues. If you have had pain for three months from an osteoporotic compression fracture, the procedure probably is indicated. However, it is not indicated if you have normal bones and the fracture is from a trauma.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.