Wellmark Reverses Negative Coverage Policy for Balloon Sinus Ostial Dilation (11/19/20)

Following extensive advocacy efforts by the AAO-HNS, the Iowa Academy of Otolaryngology, and other stakeholders, Wellmark revised its medical policy, “Functional Endoscopic Dilation of the Sinuses and Sinus Implantable Devices” effective October 2020. Wellmark, which operates commercial insurance plans in Iowa and South Dakota, will now include coverage of balloon ostial dilation (BOD) for chronic rhinosinusitis in adults when specific clinical criteria are met. Wellmark previously deemed this procedure investigational. Wellmark joins the growing list of payers that have responded to AAO-HNS advocacy efforts by enacting coverage of BOD in the past year, including the Blue Cross Blue Shield Federal Employee Program, Blue Cross Blue Shield of North Carolina, and Blue Cross Blue Shield of Idaho.