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Were You Denied Coflex Surgery for Your Spinal Stenosis?

Gianelli & Morris is Ready to Help

If you have been denied Coflex surgery for spinal stenosis, or if you paid out of pocket for Coflex because your insurance wouldn’t cover it, our California insurance law firm would like to hear from you. Spinal stenosis is a narrowing of the interior space of the spinal column in the neck (cervical spine) or lower back (lumbar spine), which can put pressure on the spinal nerves protected by the vertebrae. Symptoms of lumbar spinal stenosis, which afflicts 1.6 million people in the U.S. each year, include tingling, weakness or numbness in the leg or foot, leg pain and cramping in the legs when walking or standing, and back pain.

Sufferers of lumbar spinal stenosis are initially thrilled to learn there is a procedure that can relieve the pain of their condition without having to go through spinal fusion surgery. Their hopes are soon dashed, however, when they find out their health insurer won’t cover the procedure. Anthem, Blue Shield, Aetna, Health Net, and others have been refusing to cover the procedure, known as Coflex surgery, claiming the procedure is experimental, investigational, or not medically necessary. None of these claims are true, and insurance companies should not be denying coverage for this valuable treatment.

The California insurance bad faith lawyers at Gianelli & Morris focus their practice on helping individuals who are being unfairly treated by their insurance company. If your insurer has refused to cover your Coflex request, call our office in Los Angeles at 213-489-1600 or statewide at 866-821-4104.

What is Coflex?

Coflex, also known as Paradigm Spine, is an Interlaminar Stabilization Device that is implanted between the adjacent lamina of one or two contiguous lumbar motion segments. This minimally invasive surgery involves a shorter operation and shorter hospital stay than fusion surgery and may even be performed as an outpatient procedure. Patients who receive Coflex recover quickly and are able to resume a high quality of life, including their formerly active lifestyle.

Other advantages of Coflex over spinal fusion include greater mobility at the treatment level and natural movement at adjacent levels in the spine, as well as faster and sustained pain relief. As a non-fusion option, Coflex stabilizes the spine while also preserving motion.

Coflex is recommended for individuals suffering from a one or two-level (single or double-level) lumbar stenosis at one or two contiguous levels of vertebrae from L1 through L5. Coflex treats persons who have moderate to severe spinal stenosis after decompression and also meet the following criteria:

  • Skeletally mature
  • Do not have gross instability of the spine
  • Experience relief during spinal flexion from symptoms of leg/buttocks/groin pain, with or without back pain
  • Have undergone at least six months of non-operative treatment, such as NSAIDs, rest, restriction of daily living activities, physical therapy, or steroid injections, and still have persistent pain

Coflex is proven safe and effective and is already in wide use

It is hard to understand why some insurers claim that Coflex is experimental or investigational and use that claim as a basis to deny coverage of Coflex. In fact, Coflex is FDA-approved and well-documented in the medical literature. Coflex received FDA pre-market approval to treat lumbar spinal stenosis, it has a 20-year clinical history, and it is in use in over 40 countries in Europe and around the world. The method utilized by Coflex – coverage of decompression with interlaminar stabilization for select patients with lumbar spinal stenosis – has also been recommended by the International Society for the Advancement of Spine Surgery (ISASS).

Coflex has even been covered by some insurance carriers in the United States. It was first covered for Medicare policies in 2017 by Highmark, a Blue Cross Blue Shield affiliated organization covering five million members in the eastern U.S. Highmark made the decision to only cover Coflex versus other devices, citing over 85 peer-reviewed articles supporting the device’s safety and efficacy.

Gianelli & Morris has a proven record of fighting insurers over lumbar spine treatments

Gianelli & Morris has had experience and success handling similar complaints involving artificial lumbar disc replacement (ADR-L) surgery. Here too, the insurance companies denied ADR-L requests for the same basis they are now denying Coflex – claiming the procedure was experimental, investigational or not medically necessary. We have had cases against Aetna, Blue Shield of California and UnitedHealthcare and have won class action certification in several of these. Obtaining class certification is a huge step in changing insurance carrier behavior when they engage in a practice of routinely denying a certain procedure (like ADR-L or Coflex) without making an individualized determination whether the procedure would help their insured in a particular instance.

If you have been turned down for Coflex by your insurance company, call Gianelli & Morris for a no-cost, confidential consultation regarding your claim. You may be a likely candidate to represent a class of plaintiffs and help obtain justice for yourself and others in the same situation. Your insurer should do what’s right and best for your health, and we are here to make sure they do.

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