Eligibility criteria for each insurer and analysis of agreement between insurers.
| Payer | Criteriaa, b | Total Number of Criteria Needed for Coverage | |||
| Symptom | Examination | Imaging | Conservative Treatment | ||
| NASS | 1 | 0 | 1 | 1 | 4 |
| BCBS of NJ | 2 | 2 | 1 | 2 | 9 |
| Independence Health Group (NJ) | 3 | 2 | 1 | 2 | 11 |
| Clover Health (NJ) | 2 | 2 | 1 | 2 | 9 |
| Lifetime Health Care Group (NY) | 2 | 1 | 1 | 2 | 7 |
| Emblem Health Group (NY) | N/A | N/A | N/A | N/A | |
| Health First (NY) | N/A | N/A | N/A | N/A | |
| Independence Health Group (PA) | 3 | 2 | 1 | 2 | 11 |
| UPMC Health (PA) | 1 | 2 | 2 | 3 | 11 |
| Highmark Group (PA) | 2 | 2 | 1 | 2 | 9 |
| Aetna (National) | 2 | 0 | 2 | 3 | 9 |
| Cigna (National) | 2 | 2 | 1 | 2 | 9 |
| United (National) | 1 | 0 | 1 | 2 | 4 |
| Kaiser (National) | 0 | 0 | 0 | 0 | 0 |
| Consensus agreement? | N | N | N | N | |
| 80% agreement between insurers | N | N | Y | Y | |
| Agreement between insurers | 55% | 64% | 73% | 73% | |
| Percent more restrictive than NASS recommendations | 73% | 73% | 18% | 91% | |
Abbreviations: BCBS, Blue Cross and Blue Shield; NASS, North American Spine Society; UPMC, University of Pittsburgh Medical Center.
↵a Emblem Health group and Health First use Orthonet for their guidelines, which was not publicly available for analysis.
↵b Specific subcategories of coverage criteria for different insurers as described by their coverage recommendation documents.