Patient Advisory - Toe Joint Replacement:

IMPORTANT UPDATE TO CIGNA'S POLICY ON COVERAGE:  March 2009

We are pleased to announce that Cigna has changed its policy to deem our toe implants medically necessary for the treatment of Hallux Valgus or Hallux Rigidus.  We applaud their decision.  We would expect other carriers to follow Cigna and Aetna's policy change.

Click here for the direct link to Cigna's policy page.

Coverage Policy

CIGNA covers partial or total replacement of the first metatarsophalangeal (MTP) joint as medically necessary as an alternative to arthrodesis when BOTH of the following criteria have been met:

• Persistent severe disabling symptoms from hallux valgus or hallux rigidus due to degenerative joint disease of the first MTP joint

• Failure of conservative medical management

The following is the history of our discussions with Cigna:

 “What do I do if my insurance plan is Cigna Healthcare?”

Cigna Healthcare’s clinical policy on Metatarsal Phalangeal (MTP) Joint Replacement is effective since 3/15/2006 and underwent it's last review on 3/15/2008.  Cigna Healthcare has maintained a policy position considering implants for MTP replacement and “does not cover partial or total metatarsophalangeal (MTP) joint replacement of the hallux (i.e., great toe) because there is insufficient evidence to demonstrate that this procedure is comparable to other treatment options and is therefore considered experimental, investigational or unproven.”, and therefore has declined reimbursement to physicians and patients for treatment with any MTP Implants.

Link to Cigna's policy page

As a patient this means that even if your doctor has chosen the HemiCAP^® MTP implant resurfacing system or any other implant as the preferred treatment for your Great Toe, Cigna Healthcare will not pay for it.

Arthrosurface has contacted Cigna Healthcare and submitted a formal request to review its policy again with regards to our implants. This submission included the following: a letter to Cigna Healthcare and a recently published study of our implant in a peer-reviewed medical journal.  Cigna was also informed of the recent change to Aetna Insurance's policy that DOES approve coverage of the Arthrosuface implants. The full documents are included below.

  View Arthrosurface's letter to Cigna

 
 
   View Hasselman et al. peer reviewed publication

Reference:
Hasselman CT, Shields N. Resurfacing of the First Metatarsal Head in the Treatment of Hallux Rigidus. Techniques in Foot & Ankle Surgery 7(1):31–40, 2008

Cigna Healthcare responded stating that they do not believe a change in Cigna's policy is warranted at this time but will review and update the policy in the first quarter of 2009.

 Cigna's response letter

Cigna Healthcare reviewed the above mentioned publication by Hasselman and Shields (2008). The study included an average follow-up of 20 months in 25 patients treated with metatarsal HemiCAP resurfacing. Patients achieved significant pain reduction and functional improvement and demonstrated a very high satisfaction rate, indicating that all patients would undergo the procedure again. Despite very promising results, Cigna Healthcare concluded that the study was limited due to the <30 month follow-up as compared with arthrodesis.

Arthrosurface further asked Cigna Healthcare if they would consider approving individual cases on an interim basis based on the need of the individual patient and the specific recommendation of the doctor.  Cigna replied stating “case by case consideration is reviewed during Cigna standard appeal process undertaken by the individual in the event of a denial for coverage.” The HemiCAP^® system would be targeted to those patients where maintaining motion of the joint was a critical factor in the patient's occupation or lifestyle. 

  View Cigna's Appeals Policies and Procedures

If you are insured by Cigna Healthcare, it is likely that you will not have any MTP Implant treatment option afforded by your plan.  Cigna Healthcare will pay for arthrodesis (fusion) as a treatment for patients with pain and/or degenerative changes of the first or other metatarsal phalangeal joints.  Fusion is a procedure where the metatarsal bone and the phalangeal bones are set at a predetermined angle and permanently fixed with metal screws. 

Be sure to discuss with your doctor what treatment options are available to you under your health care plan. Your human resources or benefits department may have other options available to you, or may benefit from your feedback, and experience with the healthcare plan they have purchased for their employees.

Arthrosurface is not in a legal position, as an implant manufacturer, to cause Cigna Healthcare to change its policy of denying reimbursement regarding MTP implants.  If you are a participant in an Cigna Healthcare plan and have been denied coverage, you may wish to check with your Human Resources or Benefits department to see if you are in a legal position as an Cigna Healthcare plan participant to further address Cigna Healthcare's policy position.