ProDisc PAL (Patient Assistance Line). Assisting patients with obtaining insurance coverage for ProDisc.
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1 ProDisc PAL (Patient Assistance Line). Assisting patients with obtaining insurance coverage for ProDisc. Patient Assistance Line (PAL) Instruments and implants approved by the AO Foundation
2 Patient Assistance Line (PAL) The ProDisc Total Disc Replacement product line is comprised of spinal implants. If your surgeon has identified you as a candidate for a ProDisc and you would like to learn more about how you may be able to obtain insurance coverage for this procedure, please consult your ProDisc PAL: CALL Synthes ProDisc PAL (Patient Assistance Line)
3 How will my ProDisc PAL assist me with my efforts to obtain insurance coverage? The ProDisc PAL is a reimbursement support service that assists you, the patient. Your PAL is dedicated to working together with your surgeon, medical office, and insurance provider. Your ProDisc PAL will assist you by: Requesting coverage from your insurance provider. The ProDisc PAL will contact your insurance provider to determine your benefits, obtain preauthorization requirements, and work with your surgeon s office to obtain and submit required documentation on your behalf. Initiating and coordinating appeal(s). If your initial request for coverage (preauthorization) is denied, your PAL will coordinate the necessary appeals with your insurance provider to contest the denial. Facilitating an external review. If coverage is still denied after the insurance company reviews your claim internally, the PAL will facilitate an external review with an independent arbitrator. Depending on your diagnosis, insurance provider, and number of appeals already submitted, your case may take anywhere between 2 weeks to 3 months for a final decision to be rendered. ProDisc PAL (Patient Assistance Line) Synthes
4 Patient Assistance Line (PAL) Why should I use the ProDisc PAL service? It saves you time and stress. Your ProDisc PAL is comprised of reimbursement experts. PAL s approach often results in successful appeals, faster case-by-case approvals, and more universal policy changes. There is no cost for PAL assistance. What guidelines about the ProDisc PAL service should I be aware of? Your case must be deemed medically necessary by your surgeon. Your case must meet all FDA-approved indications. Your case must not be federal or state payer-related (Medicare, Medicaid, TriCare, or worker s compensation). Synthes ProDisc PAL (Patient Assistance Line)
5 How successful is ProDisc PAL assistance? Through the efforts of the ProDisc PAL and all the medical professionals who have helped advocate for patient access to total disc replacement, approximately two thirds of insured patients now have access to ProDisc-C and approximately one third have access to ProDisc-L. Over 86 million people are now covered for cervical disc replacement (compared to 3.6 million covered lives in December 2007 when ProDisc-C was FDA approved). Over 40 million people are now covered for lumbar disc replacement (compared to 22 million covered lives in August 2006 when ProDisc-L was FDA approved). Over the last year, more than half of patients who utilized the PAL process obtained coverage. As insurance providers gain awareness of the demand for this procedure and understand the clinical benefits, the more likely they are to provide coverage for their customers. Disclaimer: Synthes bears no responsibility or liability for the results of the use of the PAL services. Information in this guidance document does not guarantee coverage or payment for any particular technology or procedure. Data compiled by Synthes, Inc. from the Atlantic Information Service (AIS) Directory of Health Plans 2010, individual published medical coverage policies, and internal Synthes sales data. ProDisc PAL (Patient Assistance Line) Synthes
6 Patient Assistance Line (PAL) What is my responsibility as a patient? Call your ProDisc PAL now: , Monday Friday 9am 8pm EST. During non-business hours, you may leave a detailed voic . Calls will be returned within one business day. Coordinate with your surgeon to complete the required documentation. Communicate regularly with your PAL for updates on your case. Synthes ProDisc PAL (Patient Assistance Line)
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8 Synthes Spine 1302 Wrights Lane East West Chester, PA Synthes, Inc. or its affiliates. All rights reserved. ProDisc and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 11/11 J11107-B
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