I was speaking to Rick Delamarter earlier this month. At the end of February, he is addressing a meeting with BC/BS explaining all the ProDisc data and basically pitching ProDisc again. As I've seen in the 2+ years since Charite' approval and the fiasco with insurance reimbursement and acceptance of the device, the folks at Synthes have learned well the lessons taught by J&J's Charite' experience. Armed with this knowledge, they will do a much better job and I hope that they will be able to bridge the gap between what the surgeons know as an improvement in the standard of care and what the insurers see as a big risk and more money out of their pocket.
I wish I could say that I thought the insurers were trying to protect us, but I firmly believe that this is just about money. Hopefully an overwhelming case will force the pencil pushers to yield to the doctors and the data. Unfortunately, media hype, pressure from competitors, lawyers taking advantage of new technologies (as in the Charite' lawsuits), and some doctors who see the value in being the leader of the ADR naysayers (Rosen, Van Ooij) will provide political cover for the insurers to save themselves money and delay approval of reimbursement.
Hopefully, Dr. Delamarter will knock their socks off next week. Hopefully, the insurers will put patient welfare and appropriateness of medical care first. As with FDA approval, I'm not holding my breath. The insurance landscape will change in the years to come. Will it be soone enough for you? I hope so.
Mark
PS... I'll try to get more details about the meeting...
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