Why Isn’t Lumbar Disk Replacement Covered in Alabama?

by JAne ehrhArdt

Currently, although BlueCross BlueShield of Alabama covers cervical disk replacement, the insurer does not reimburse for a lumbar total disk replacement (TDR). “Their guidelines still say it’s experimental, even though it’s one of the most studied topics in spine,” says Mark Prevost II, MD and orthopedic spine surgeon with Southern Orthopedic.

Last year, Aetna faced a 239-patient class action lawsuit over their lapse in coverage for lumbar disc replacement, having deemed the procedure as “experimental and investigational”, according to Becker’s Spine Review. They settled that suit in December. In other states, BlueCross entities have already approved the procedure. “It’s not ‘if’ it’s going to happen here, too, but when it’s going to happen,” Prevost says.

During his fellowship at Texas Back Institute, which celebrated their 3,000th lumbar disk replacement over a 20-year span, Prevost estimates that he completed around 100 disk replacement procedures. He returned