2014 Payer Advocacy Success Case 5

Our client’s medical technology hotline was getting calls from confused providers because there was another Product listed with a similar name to our client’s Product on a major payer’s medical policy.  GIRS followed up with the corporate office of the insurance company and discussed the issue with their Medical Director.  The Medical Director stated that the Product with the similar name was a new product that was non-covered and should not be mistaken for our client’s Product.  To reduce confusion, GIRS and the payer developed a solution to reduce the confusion by adding the manufacturer’s name next to each Product.  While speaking with the Medical Director, GIRS also discussed the payer requirements to establish positive coverage for our client’s Medical Product.  The Medical Director agreed to review the new clinical study that will be sent in early 2015, in time for the payer’s next review in March 2015.