Embolization Insurance Denial Attorney in California

Page Contents:

• What is Embolization?
• Why Could Embolization Be Denied by Insurance?
• What Should You Do if Your Embolization Treatment Is Denied by Insurance?
• Which Insurers Are More Likely to Deny Embolization?
• How Can Attorney Scott Glovsky Help with Embolization Denied by Insurance?

Essentially, embolization procedures halt blood flow to a specific blood vessel. Embolization for bleeding is usually performed for patients who have excessive or prolonged bleeding. Prolonged bleeding can occur with nosebleeds and abnormal blood vessels in the neck, face, or mouth areas. There are many additional medical applications for embolization, including for those with a vascular malformation or a tumor. Uterine artery embolization can result in dramatic improvements; about 85 percent of those who undergo this type of embolization see a significant improvement in symptoms.

If your doctor believes you could benefit from embolization, it can be disheartening and frustrating when you find your insurance company has denied your claim. While you may feel like giving up, this is not a time to do so. This is the time when you need a strong legal advocate who will fight for you, your rights, and your future. Attorney Scott Glovsky is that advocate and is ready to help you through this difficult situation.

What is Embolization?

Embolization is performed by placing a tiny catheter inside a blood vessel that supplies the bleeding area. The physician uses image guidance to carefully navigate the catheter to a point where a material is used to block the bleeding. Some of the materials used include:

• Tiny balloons that temporarily or permanently block a bleeding blood vessel
• A sponge-like gelatin foam material that dissolves in a few days
• An adhesive substance like liquid superglue that hardens quickly to seal abnormal vessels
• Tiny metallic coils made of platinum and stainless steel that can be precisely placed
• Liquid sclerosing agents, like alcohol, that destroy tissues on contact, causing the abnormal blood vessel to close.
• Particulate agents, including various sizes of spheres, that permanently block small blood vessels

Arterial embolization blocks blood flow to a specific area, chemoembolization combines chemotherapy and embolization, and radioembolization combines radiation therapy with embolization. Embolization can treat vascular malformations, aneurysms, uterine fibroids, tumors, menstrual irregularities, benign prostate hypertrophy, brain aneurysms, osteoarthritis, gastrointestinal bleeding, varicoceles, cancer, and more.

Prior to an embolization procedure, you will receive mild sedation, and the site will be numbed.  A small puncture will be made in your skin near the wrist, groin, or neck area, and a catheter will slide through the puncture, advancing to the treatment area. Imaging technologies allow the radiologist to view the area being treated.

In some cases, a special dye will be injected through the catheter to help the physician see the blood vessels and blood flow. The embolic agent will be delivered; then the physician will look at the vessel to see whether the bleeding has stopped. The catheter is then removed, and a small bandage is placed over the puncture site.

Why Could Embolization Be Denied by Insurance?

If your embolization treatment has been denied by your insurer, you must read the denial letter you received carefully to determine why the treatment was denied. It could be something as simple as missing information or an error on the form, both of which can be easily fixed and resubmitted. Your letter may say that the embolization treatment was denied because the insurer does not consider it medically necessary or because the treatment is experimental or investigational.

Any of these words often mean the treatment or procedure costs more than the insurer wants to pay. Insurance companies are not the “friends” that are portrayed in television commercials. They are businesses that care most about their financial bottom line and will deny as many claims as possible for a healthy bank balance. Whatever the reason given in your denial letter, it is important that you not give up. There are avenues you can pursue to persuade your insurer to pay for your embolization.

What Should You Do if Your Embolization Treatment Is Denied by Insurance?

When facing an insurance denial, the best thing you can do is speak to a knowledgeable insurance denial attorney who can guide you through the appeal process. You can file an internal appeal, which means asking your insurer to take another look at your claim. It can help to submit a letter from your physician that details why the embolization treatment is necessary for your health.

Your insurance company may reverse its initial decision and pay for the treatment. You can file a third-party external appeal with a neutral party if it does not. The decision made by this third party is legally binding on your insurer. Very few people file appeals, yet of those who do, almost half are successful, so pursuing an appeal is the best idea.

Which Insurers Are More Likely to Deny Embolization?

Embolization is sometimes done in an emergency situation during surgery. It would be unusual – but not impossible – for an insurance company to deny embolization in this type of situation. When it is a scheduled procedure, embolization is still used to stop bleeding, which can be critical. While any insurance company can deny an embolization procedure, some may be more likely than others to do so. If you live in the state of California, you may have one of the insurance companies listed below. Attorney Scott Glovsky has gone up against the biggest insurance companies with positive results.

• Anthem Blue Cross
• Blue Shield
• Health Net
• Kaiser
• Cigna
• Aetna
• Medi-Cal Managed Care Plans (Anthem Blue Cross, Promise Health Plan, Health Net, Molina)

How Can Attorney Scott Glovsky Help with Embolization Denied by Insurance?

Embolization denied by insurance can be a difficult situation that benefits from an attorney who spends every day making insurance companies do the right thing. Attorney Scott Glovsky has experience working on the “other” side. When he first began his career, Scott worked in large corporate law firms defending insurance companies. This allows him to understand how these companies think and operate. Scott is well-respected in the industry and has a solid reputation from former clients and from other attorneys. He and his legal team take fewer cases so that each client receives tremendous time and care. This is no “assembly line” law firm. Contact the Law Offices of Scott Glovsky today.