Blue Cross, Blue Shield, Reverse Payment Decision

Blue Cross Blue Shield, Michigan’s largest health insurer, had planned to stop paying for knee arthritis injections.

Then it reversed its decision.

According to J.C. Reindl of the Detroit Free Press, the company told medical providers last week that it will continue paying for hyaluronic acid injections, also known as viscosupplementation therapy, as it reviews additional information about the injections’ effectiveness.

“There is great controversy regarding the effectiveness of this treatment nationally,” said Blue Cross spokeswoman Helen Stojic.

The reversal came after objections from orthopedic doctors, including members of the Michigan Orthopedics Society, who say the injections help many arthritis sufferers by reducing pain, improving mobility and delaying the need for a knee replacement.

“At least two-thirds of my patients with mild to moderate arthritis get a pretty significant benefit from these shots,” said. Joseph Guettler, M.D., an orthopedic surgeon with Beaumont Health. For the other third of his patients, such as those who are bone-on-bone and not candidates for injections, “sometimes the arthritis is too far gone, and they really need to move onto something like knee replacement,” he said.

Guettler emphasized to Reindl that even successful injections don’t make the arthritis go away. All they generally do is buy patients “a few years” before needing a replacement, he said. The American Academy of Orthopedic Surgeons, following a review of multiple patient studies, stopped recommending hyaluronic acid injections for knees in 2013 “based on a lack of efficacy, not on potential harm,” according to Reindl.

A course of treatment may consist of three to five hyaluronic acid injections done over three to five weeks. A single-shot treatment is also available. Proponents say the effect of the shots can last six months or longer.