Pre-Authorization

Before undergoing surgery using the Coflex® Interlaminar Stabilization® device, work with your doctor to ensure it will be covered by your insurance. Health plans require members to receive a pre-authorization before undergoing a procedure so they can confirm it is medically necessary before agreeing to cover it. The pre-authorization process can last anywhere from 3-15 days, but may take an additional 30-60 days if your case is denied and you choose to submit an appeal.

Initiate the Pre-Authorization

Verify benefits and submit information on device. (if necessary, steps 2-5)

Peer-to-Peer

Your doctor will discuss the medical necessity of your case with a Medical Director from your insurance provider.

1st Level Appeal

Your doctor requests a new Medical Director to review submission.

2nd Level Appeal

Your doctor requests a new Medical Director to review submission.

External Appeal

After appealing internally, you may pursue an appeal with the applicable State Department of Insurance.

Your Role in the Appeals Process

If your health plan denies coverage for the procedure, you may feel discouraged. But don’t give up, because there are steps you can take to get your procedure covered. Submitting an appeal allows you to ask for reconsideration as well as providing you with more information about the procedure and why it is necessary.

If this happens, we encourage you to follow the steps below:

  • Find the reason for the denial by reading the pre-authorization denial letter.
  • Determine the insurer’s appeal process (varies by insurer).
  • Work with your physician to submit your formal appeal within the necessary timeframe.
  • Keep notes and detailed records, including names and dates of any individuals you speak to.

We also recommend writing a letter describing how your pain has affected your life, and why this procedure will help. Include your symptoms, activities you are no longer able to participate in because of your pain, and treatment options you have already tried. This can be a valuable tool in helping your case.

Talk to Your Insurance Provider About the Coflex® Procedure

As you move through the process of receiving coverage for your Coflex® procedure, remember to take notes, keep track of your conversations, and advocate for yourself. Talking with your insurance provider allows you to give your input on why this procedure is necessary for you. This can help influence how your case is handled.

Before you speak with your insurance, set goals for what you would like the outcomes of the conversation to be, such as learning what the next steps are, finding out the reasons behind the denial, or having your case expedited. To speak with your insurance provider, call the general customer service line, often located on the back of your insurance card, and let the agent know you have received a denial and want to speak to a supervisor.

A few questions you may want to ask include:

  • What is the current status of my Coflex® surgery case?
  • Can I get my Coflex® surgery case expedited?
  • Can you provide me with more information about why my Coflex® operation was denied?

  • What additional information do you need from me to help?

  • What are the next steps and what is the timeline?