ReActiv8 Support & Verification Program

Coverage for ReActiv8

Mainstay Medical’s ReActiv8 Support & Verification Program (RSVP) is facilitated by experienced patient access specialists who will work directly with you, your provider, and your health insurance company in an effort to obtain coverage for the ReActiv8 system. With your consent, the RSVP team will submit a prior authorization request (if applicable) and appeal service denials, until a final decision is made. Although there can be no guarantee of coverage approval, our program continues to work on your behalf until all avenues are exhausted.

ReActiv8 is a novel therapy designed to restore neuromuscular control of your spine, increase function, and decrease pain.

Start Your ReActiv8 Journey Today

Please fill out the following form to enroll in the RSVP program.

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    Please click the button below the Consent and Authorization text to enroll in the RSVP program after completing all the required fields and signing the form.

    By clicking "Submit" I agree to receive emails, text messages, and phone calls, it may be recorded and/or sent using automated dialing or emailing equipment or software provided as long as my data will be held securely and will not be distributed to third parties. I agree to receive messages unless I opt-out of such communications. I agree to pay my mobile service provider's text messaging rates, if applicable.
    Consent and Authorization: By providing my information and signing this form, I give MML US, Inc. and its employees, agents, and contractors involved in managing the RSVP Program (collectively, “Mainstay Medical”), consent to utilize my Protected Health Information (PHI) and pursue insurance coverage on my behalf for the ReActiv8 system. I understand Mainstay Medical will act as my authorized representative to prepare and submit a pre-service or pre authorization request (prior auth.), as applicable, to my insurance company. If the prior auth. request is denied and I wish to file an appeal, I also authorize Mainstay Medical to continue acting as my authorized representative in pursuing an appeal against my insurance company. For this purpose, Mainstay Medical may use any additional PHI received from me or my physician/provider, including clinical records and insurance information, and I agree to complete (and sign) any necessary documents. I understand that participating in the RSVP Program is voluntary, and I may refuse to participate (or stop participating) without negatively affecting my treatment, insurance benefits, or physician-patient relationship. I understand neither Mainstay Medical nor the RSVP Program can promise or guarantee insurance coverage.. In addition, I authorize the above-identified physician and his/her facility/practice (“Practice”) to share my PHI with Mainstay Medical for purposes of preparing and submitting prior auth. request(s), appeal(s), grievance(s) and/or independent review(s) on my behalf to my insurance company, for purposes of obtaining ReActiv8 coverage. The following PHI may be disclosed to Mainstay Medical: Medical Records: All records, reports, charts, tests, correspondence, and notes from physician office(s), hospital(s), laborator(ies), physical therapist(s) and/or other providers, that pertain to my medical care, treatment, history, and/or prognosis relevant to ReActiv8 therapy. Insurance Records: All communications, notes, billing statements, claim forms, EOBs, enrollment information, premium information, and other relevant data to/from insurance companies, plans, administrators, sponsors, and utilization review companies, regarding processing or paying my claim(s) for insurance benefits. I understand that (i) my agreement with the above terms is voluntary and my treatment, payment, enrollment, or benefits cannot be conditioned on my signing this form; (ii) my PHI is protected by HIPAA (45 CFR Parts 160 and 164) and applicable state privacy laws; (iii) my PHI may be subject to re-disclosure without federal protection if the receiving party is not a health plan, health care provider, or healthcare clearinghouse; (iv) I am authorizing the release or exchange of my PHI to the parties named above; and (v) I can receive a copy of this form by submitting a request to Mainstay Medical. This authorization will expire one (1) year from the date entered above OR upon conclusion of my appeal process, whichever is later. I understand I can revoke this authorization at any time by notifying Mainstay Medical; however, my revocation will not have any effect on actions taken prior to the revocation.

    RSVP Program

    Increasing your Access to ReActiv8

    The RSVP Program can increase your access to ReActiv8 therapy through the submission of comprehensive requests for prior authorization, patient-based appeals with insurance companies, and external reviews if necessary.

    Prior Authorization & Appeals Process


    Request For Prior Authorization

    Your healthcare provider will provide clinical documentation to support a letter of medical necessity to your insurance company requesting prior authorization for ReActiv8. If your health plan approves, no further action is required, and the ReActiv8 procedure may be scheduled.

    This process may take 15-30 days once the request is submitted.


    The Internal Appeals Process

    If your health plan denies your prior authorization request, an RSVP Prior Authorization Specialist will help to submit an appeal letter with your clinical records on your behalf in an effort to demonstrate medical necessity. Our team will seek up to two levels of internal appeals on your behalf, although your plan may only require one level. If the plan approves, no further action is required and your ReActiv8 procedure may be scheduled.

    This process may take 30-45 days after an appeal is submitted. If a second internal (Level 2) appeal is available, it may take an additional 30-45 days.


    Your Right To An External Appeal

    If your health plan denies your internal appeal(s), you may be able to request an External Review with an Independent Review Organization (IRO). An RSVP Prior Authorization Specialist will facilitate this process on your behalf. The decision of the IRO is binding and represents the last step in the appeals process.

    This process may take 45-60 days once the external review request is submitted.

    RSVP Support Line Hours

    Monday through Friday 8:30am – 5:00pm PST


     (763) 270 – 5305