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  "documentTitle": "Nevro Corp. (NVRO)",
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  "authorName": "Kir Kahlon",
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  "notes": "Uses direct quotes from 'high volume implanters' to build credibility for the bearish thesis.",
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      "text": "KOL's indicated that payor pressure has become so onerous that many doctors have stopped implanting stimulators altogether.",
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      "text": "Reimbursement hassles – such as 50% of stimulators being denied and needing appeals – are so severe that some doctors have stopped implanting stimulations",
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      "text": "A high volume KOL indicated that reimbursement is \"getting worse year after year\" and bemoaned the amount of his time it sucks up",
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      "text": "A leading KOL stated reimbursement is \"horrible\" and \"it's financially not worth it,\" adding that he doesn't blame insurers for cracking down, given the abuse",
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      "text": "KOL's indicated that payor pressure has become so onerous that many doctors have stopped implanting stimulators altogether. One stated that he sees 50% of implants denied. Another stated that implanting is now \"financially not worth it.\" A third, speaking of insurers, said there's so much abuse that \"I don't blame them. I really don't blame them.\"",
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      "text": "\"The reimbursement sucks. Insurer rejections are the bane of my existence. Every year I spend more and more time on peer and peers. As we do more expensive stuff like stim, the insurers are raising the ante. Yes, I'm spending more energy on it. It's getting worse year over year. It's an expensive technology. Reimbursement pressure has gradually increased and slowly trailed the proliferation of stimulators. Right around the time that Nevro appeared. The stim market grew and insurers pushed back. Blue Cross, any of the blues, are all bad. They're the worst.\" –KOL, high volume implanter",
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      "text": "\"I have one full time person who dots the i's and crosses the t's. They handle denials, then the appeals, then the independent medical review denies it again. Most doctors don't take the time and don't bother. Some have stopped implanting stimulators because it's such a pain in the ass. 50% are initially denied and I get 70% covered. It's a lot of hassle to go through.\" –KOL, high volume implanter",
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      "text": "\"Reimbursement is horrible. It's financially not worth it. There's not much money in it. There's not much at all. And the equipment now has to be bought by a surgery center and there's hardly any profit in that. There's just no profit anymore. They took it all away, which is fine, I don't blame them. I really don't blame them. People abuse it\". –KOL, high volume implanter",
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      "text": "\"Some have stopped implanting stimulators because it's such a pain in the ass. 50% are initially denied and I get 70% covered. It's a lot of hassle to go through.\" — KOL, high volume implanter; \"Reimbursement is horrible. It's financially not worth it. There's not much money in it. There's not much at all. And the equipment now has to be bought by a surgery center and there's hardly any profit in that. There's just no profit anymore. They took it all away, which is fine, I don't blame them. I really don't blame them. People abuse it\" — KOL, high volume implanter; \"The reimbursement sucks. Insurer rejections are the bane of my existence. Every year I spend more and more time on peer and peers. As we do more expensive stuff like stim, the insurers are raising the ante. Yes, I'm spending more energy on it. It's getting worse year over year. It's an expensive technology. Reimbursement pressure has gradually increased and slowly trailed the proliferation of stimulators. Right around the time that Nevro appeared. The stim market grew and insurers pushed back. Blue Cross, any of the blues, are all bad. They're the worst.\" — KOL, high volume implanter",
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      "text": "Source: Consultation calls with experts",
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      "text": "16. The SCS market growth story fueled by Wall Street is false and undermined by escalating payor backlash",
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      "text": "Scorpion Capital | Nevro (NYSE: NVRO)",
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