DMX necessity letter to insurance company

Published July 12, 2015

I had a conversation with an insurance company that said they felt DMX was not necessary. Below, I copied the quick letter with research references and a explanation of each reference.  As a member you will have access to letters like this to help your patients get the care they need and explain why you did take a particular image.

Dear Insurance,

Recently you denied one of your clients reimbursement for a digital motion x-ray (DMX). During our conversation, you explained to me that a healthcare board meets four times a year to discuss if this image should be a covered entity. You sent me a letter and explained that your panel concluded that it was “investigational and not medically necessary for all indications”. You cited your references. I will list the references your “board” , as well as yourself used to determine it was a unnecessary test below with some clarifications as to how the references you and the board used to deny coverage does in fact, contradict what you have told me.

1) Dynamic motion analysis of normal and unstable cervical spines using cineradiography. An in vivo study. Spine (Phila Pa 1976). 1999 Jan 15;24(2):163-8.

Hino H1, Abumi K, Kanayama M, Kaneda K.

Please note what the authors CONCLUSION is as it pertains to DMX technology.

Different motion patterns were observed between normal and pathologic cervical spines. Cineradiographic motion analysis is a valuable adjunctive technique, especially in diagnosis or evaluation of conditions that cannot be identified through conventional radiographic examination.

As you can clearly see, this study you relied upon mentions it is a “valuable adjunctive technique, especially in diagnosis or evaluation…..

2) Fluoroscopic video to identify aberrant lumbar motion. Spine (Phila Pa 1976). 2007 Apr 1;32(7):E220-9.

Teyhen DS1, Flynn TW, Childs JD, Kuklo TR, Rosner MK, Polly DW, Abraham LD.

This study evaluated arthokinematics using DMX technology. This study that you have used to deny coverage, gathered information based solely on DMX technology. If this technology was “investigational” for your client, I am not sure you can use a study that relied on DMX technology to gather spinal mechanical information.

I am going to add a few more studies showing the importance of this technology on select patients.

Croft AC, Young DN: Videofluoroscopy: a sampling of chiropractic radiologist’s opinions. Topics Diagn Radiology Adv Imag  2(1): 4-10, 1994.

Buonocore E, Hartman JT, Nelson CL: Cineradiograms of cervical spine in diagnosis of soft-tissue injuries.  JAMA 198(1):143-147, 1966

Ruey-mo Lin MD, Kuen-horng tsai, PhD. Characteristics of sagittal alignment in flexion determined by dynamic radiographs of the cervical spine.  SPINE may 2001, volume 36, number 1 pp 236-261





One comment.

William Livingston

Do you know if the insurance company reimbursed for it after this letter?

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