Compression Treatment Insurance Denial Attorney in California
If your doctor has ordered compression treatment for a medical issue and you just received a compression treatment insurance denial, it is normal to feel frustrated and overwhelmed. Life is busy and difficult enough without having to fight with your insurance company. And even though you may have done everything right, insurers often deny claims that they feel are too expensive under the guise of the treatment not being medically necessary.
Your doctor should be the one saying what is medically necessary for you and your condition, not the insurance company. If you are facing a compression treatment insurance denial, pick up the phone and call the Law Offices of Scott Glovsky. Attorney Scott Glovsky is compassionate and experienced and will fight aggressively on your behalf to help you get the medical treatments you need.
What is Compression Treatment?
Medical issues like lipedema, lymphedema, and venous conditions can benefit from compression therapy. Compression therapy reduces swelling caused by fluid accumulation in the tissues and reduces venous reflux and venous hypertension. Venous reflux disease occurs when veins fail to properly return blood to the heart and commonly affects the legs, causing extreme pain and ulcer sores. Venous hypertension is high blood pressure in the veins in the legs. This condition can restrict the amount of oxygen reaching leg tissues and skin, resulting in painful skin ulcers, skin changes, and swelling of the legs.
Compression therapy has an anti-inflammatory effect. The mechanical pressure exerted on the skin and tissues can reduce venous pressure, placing less strain on the tissue and skin and allowing more oxygen to circulate throughout the body. Compression therapy can even be used for those who sit for long periods of time while at work, those who regularly take long flights, pregnant women, or those who stand for long amounts of time.
When compression therapy is used for venous conditions, varicose veins, and venous leg ulcers can be managed. The pressure in the veins near the ankles is seven times higher when a person is standing than when he or she is lying down. This pressure is what contributes to venous disorders. Compression garments enhance muscle action by acting as a “counterforce” that limits fluid filtration into the tissues.
Lymphedema occurs when lymph fluids accumulate in tissue space, causing extreme swelling in the affected limb along with chronic pain or discomfort. Compression treatments can help move lymphatic fluids to the center of the body where they can drain as they should, prevent an accumulation of fluids, and support the lymphatic system’s fluid transport and recovery.
Lipedema is the disproportional accumulation of fat in the legs and sometimes the arms, usually accompanied by pain in the legs. Compression treatments can provide significant relief and improve the quality of life for those diagnosed with lipedema. Compression treatments can also reduce pain, aid mobility by providing limb support, and reduce the impairment caused by skin rubbing against skin.
What Types of Compression Treatments Are There?
There are surgical treatments for lymphedema, lipedema, and venous insufficiency. For lymphedema, your doctor may recommend liposuction, lymphovenous bypass, a lymphovenous transplant, or a Charles procedure. For lipedema, tumescent liposuction is usually recommended.
Venous insufficiency that results in veins that are close to the skin can be removed through superficial vein stripping, but if deep veins are affected, angioplasty and stenting may be recommended. After any of these surgical procedures or in lieu of a surgical procedure, the following compression treatments may be prescribed:
- Flat-knit compression garments
- Adjustable compression wraps
- Night compression garments
- Bandages
- Compression bras
- Circular-knit compression garments
- Inflatable devices that fully cover the legs, inflating to provide pressure
Why Could Compression Treatment Be Denied by Insurance?
A compression treatment could be denied because the paperwork was not properly filled out, or there may be required details left off the claim. Prior authorization might have been required and not obtained, or your insurance policy may specifically exclude compression treatments. More often, treatment is denied because it costs more than the insurer wants to pay.
If this is the case, your letter denying the compression treatment will say the company determined the treatment is not medically necessary, experimental, or investigational. Whether this is actually true or not is difficult to say. If your doctor believes you will benefit from compression therapy, then that is what you should have.
The surgeries for conditions that benefit from compression therapies can cost thousands of dollars, while the inflatable devices can cost from $700 to $1,500. The compression garments are also pricey, with a single pair of compression socks costing as much as $25.
What Should You Do if Your Compression Treatment Is Denied by Insurance?
If your compression treatment has been denied by your insurer, you do have options. You can file an internal appeal which asks your insurance company to reconsider its original decision. Including a letter from your doctor with your internal appeal paperwork can be helpful. This letter should detail why compression therapy is necessary for a positive health outcome. You can file an external appeal with a neutral third party if your internal appeal is denied. The third party’s decision–after reviewing all the information – is binding on your insurer. For this reason, we suggest speaking with an experienced health insurance denial attorney before you file your external appeal.
Which Insurers Are More Likely to Deny Compression Treatments?
All insurance companies can deny treatments from time to time, although some insurers are more likely than others to do so. Californians are often insured with one of the following companies, who could deny a necessary medical treatment.
- 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 Compression Treatment Denied by Insurance?
If you are dealing with compression treatment denied by insurance, compression device denied by insurance, or compression garment denied by insurance, Attorney Scott Glovsky can help. Scott has been pursuing justice on behalf of those who are exhausted and overwhelmed since 1999. Scott never hesitates to go up against a big insurance company and has a litany of success stories to his credit. In many cases, Scott’s advocacy has made insurance companies change the way they do business. Contact the Law Offices of Scott Glovsky today.