Table 6

Insurance guidelines and availability.

Established
Guidelines		ContractedIn-Houseb Publicly Available
Evicore

  1. BCBS of NJ

  2. Clover Health NJ

  3. Highmark (PA)

  4. Cigna (National)

 Yes
AIM Specialty Health

  1. Independence Health group (NJ)

  2. Independence Health group (PA)

 Yes
Orthonet

  1. Emblem Health (NY)

  2. Health First (NY)

 No
Lifetime Health Care Group (NY)X Yes
UPMC (PA)X Yes
AetnaX Yes
UnitedX No
Kaisera X Yes

  • Abbreviations: AIM, American Imaging Management; BCBS, Blue Cross and Blue Shield; UPMC, University of Pittsburgh Medical Center.

  • ↵a Kaiser is the only company that has no pre-surgical stipulation for lumbar decompression.

  • ↵b Eight of the 11 insurance companies investigated establish their surgical guidelines with a third-party company. Four companies establish their guidelines in house.