WCDefenseCA

Spinal surgery has been in the news recently… sort of.  The issue that has captured the attention of the media, the California Workers’ Compensation Institute, and even the legislature, isn’t the need for “actual” spinal surgery, but the removable spinal implants, commonly known as neural stimulators, which are performed over the course of an hour or so in out-patient settings.

Currently, Labor Code section 5318, allows “implantable medical devices” to be reimbursed separately at the provider’s cost, with an additional $250 in fees.  The problem with this is that the procedures (not just the equipment) already reimbursed and provide for the cost of the equipment.

Senate Bill 959, recently sent to the Committee on Insurance, would repeal section 5318, allowing for the (sane) reimbursement scheme under the Official Medical Fee Schedule, allowing for the insurer/self-insured employer to reimburse the cost of the procedure, and the facility performing the procedure to pay for the equipment out of that reimbursement.

According to the CWCI, the double-dipping of these devices and similar equipment increased the cost of claims by an average of $20,137 in 2010 (or adding $67.5 million dollars to the cost of doing business in California).

Here’s hoping the legislature delivers (and quickly).