The first step toward patient
insurance approval

MyCartilage Care can provide patient support by helping to manage the insurance process. It offers:

  • Patient benefit investigation
  • Predetermination and prior authorization management
  • Reimbursement support

STEP 1:

Download and complete the patient enrollment form

Click here

STEP 2:

Select the patient’s insurance carrier and confirm the specific medical inclusion criteria

STEP 3:

Fax the enrollment form and all supporting documentation to
855-803-9485

Resources to assist with approvals and denial appeal can be found at:
MyCartilageCare.com/approval

  • Insurer inclusion/exclusion criteria
  • Dictation guide for common insurer inclusion criteria
  • Letter of Medical Necessity assistance
  • Peer-to-Peer guidance
  • Patella clinical review
  • Reimbursement guide

For assistance with patient insurance approvals, call your MyCartilage Care Case Manager at 877-872-4643 or visit MyCartilageCare.com/approval

 

insurance approval success rates*

85% of all MACI cases were approved on initial submission

 

MACI insurance approval specific to patella cases:

  • 82% Approved on initial submission (25-30 days)
  • 5% Approved on appeal (+20-25 days)
  • 9% Not appealed & 4% Denied after appeal

UnitedHealthcare

UnitedHealthcare has expanded its medical policy for MACI to include coverage for adult patients with symptomatic full-thickness cartilage defects of the knee for patella and multiple cartilage defects.

The revised policy is effective February 1, 2021.

UnitedHealthcare is the largest commercial payor in the United States, covering more than 26 million lives. More MACI patients are covered by UnitedHealthcare than any other plan.


MACI is widely reimbursed and included on a majority of national insurance plans. To see a list of insurers, please visit MyCartilageCare.com/approval.
 

*Data on file. MACI cases activated between January 2020 and December 2020. Insurance approval is defined as payor pre-authorization for the MACI procedure.