Anesthesia is a medical intervention that prevents patients from feeling pain during certain medical procedures, including any type of surgical procedure. Anesthesia can be delivered via gas that is inhaled through a mask, an IV line, a catheter placed in the space outside the spinal cord, an injection, or as a topical lotion or spray, eye drops, or even a skin patch. Before anesthesia was introduced about 175 years ago, patients who had no choice but to undergo surgery were fully conscious during the procedure, thus feeling pain as well as the resulting emotions.
While modern anesthetics are considered safe, some patients may experience confusion, breathing problems, or allergic reactions from the anesthesia. Since anesthesia is necessary for many different medical procedures, an anesthesia insurance claim denial can feel like a slap in the face. After all, how can you have a medical procedure you need if your insurer refuses to pay for anesthesia? It can be extremely beneficial to speak to a strong legal advocate like attorney Scott Glovksy, who will fight for your rights, your health, and your future.
Overview of Anesthesia Procedures
General anesthesia is given for complex surgeries, affecting the entire body, and administered through an IV line or as an inhaled gas. Monitored sedation allows the patient to remain conscious while relaxing the body and perhaps even inducing sleep. Complex dental work or colonoscopies often implement monitored sedation. Regional anesthesia numbs pain and sensation in a specific body part.
As an example, a woman undergoing a C-section could be given general anesthesia or could be given regional anesthesia that numbs the body from the waist down, leaving the patient awake and aware. Local anesthesia blocks pain in a small, specific body area, such as an area that needs stitches, leaving the patient awake, but comfortable. According to the Mayo Clinic, complications from anesthesia occur in less than one percent of those who undergo general or regional anesthesia.
Monitored anesthesia care (MAC) is a planned procedure in which the patient is given local anesthesia along with sedation and analgesia and is the first choice in between 10 and 30 percent of all surgical procedures. MAC is preferred by many anesthesiologists as it provides safe sedation, control of patient anxiety, and pain control while protecting airways and allowing the patient to be discharged more quickly than with general anesthesia.
Anesthesia for CT or MRI scans is sometimes used, although it is not typical. When children or uncooperative adults (i.e., those with mental illnesses, or those with head injuries) must have a CT scan, they may be given general anesthesia to minimize motion and get a good scan. As for MRIs, patients with anxiety, claustrophobia, or a condition that would result in physical pain may have anesthesia with their MRI. Since it is difficult for children to remain still, as required in an MRI, anesthesia could be used in this situation as well.
Why Are Anesthesia-Related Insurance Claims Denied?
One of the most common reasons related to an anesthesia insurance claim denial is that it was “not medically necessary.” MAC denials are the most commonly seen claim denial, while anesthesia for MRIs and CT scans is also a fairly commonly denied insurance claim. Your insurance company is unlikely to say that anesthesia is experimental or investigational since it has been around for a very long time, but they may say the anesthesia was not medically necessary. In some cases, your surgery and anesthesiologist are billed separately, and administered by providers who may or may not be affiliated with your doctor.
As an example, even if your surgical procedure is done by an in-network surgeon at an in-network facility, the anesthesiologist could be out-of-network. If you receive an anesthesia insurance claim denial, don’t panic, and don’t give up. Call attorney Scott Glovsky to discuss the issue. You may find that your insurance company can be persuaded by Scott to pay for your anesthesia.
What Should You Do Following an Anesthesia Insurance Claim Denial?
Following an anesthesia insurance claim denial, you have the right to file both an internal appeal and an external appeal if the internal appeal is unsuccessful. There are specific rules and time deadlines associated with these appeals, so it is beneficial to have an experienced insurance claim denial attorney by your side. An internal appeal essentially asks the insurance company to reconsider its denial decision. If they still deny the claim, you can file an external appeal with a neutral third party. The decision of this third party is legal and binding on the insurance company. You may submit a letter from your doctor detailing why anesthesia was/is necessary for your medical procedure with your internal appeal.
Which Insurance Companies Are Most Likely to Deny an Anesthesia Claim?
Although any insurer can deny an anesthesia claim, the following California insurers could potentially deny your claim.
- Anthem Blue Cross
- Blue Shield
- HealthNet
- Kaiser
- UnitedHealthcare
- Aetna
- and others
How Can the Law Offices of Scott Glovsky Help with an Anesthesia Insurance Claim Denial?
Following an anesthesia insurance claim denial, it is important that you speak to a knowledgeable insurance claim denial attorney from the Law Offices of Scott Glovsky. Attorney Scott Glovsky and his legal team have a mission to help those who have been wronged by their insurance company. We truly care about your cause and as a result of that care, our goal is to listen to you, support you, be responsive, and put your needs first. If it is important to you to be treated with dignity and respect while a highly skilled legal team fights for your rights, then your choice is clear—the Law Offices of Scott Glovsky. If results matter, hire us! Contact the Law Offices of Scott Glovsky today.