Osteoarthritis is the most common type of arthritis, affecting millions of people across the globe. When the protective cartilage that cushions the ends of the bones wears down over time, the hyaluronic acid—a molecule found naturally throughout the human body that provides lubrication and cushioning—becomes diluted. This results in the degradation of cartilage tissues and increased joint pain. Osteoarthritis is most commonly seen in the knees, hands, hips, and spine, although it can damage any joint in the body. Osteoarthritis cannot be reversed, although receiving certain treatments and staying as active as possible can slow the progression of the disease.
Osteoarthritis of the knee causes pain, stiffness, tenderness, loss of flexibility and mobility, swelling, and even a “grating” sensation when you use the joint that creates crackling or popping noises. According to the National Institute of Health, about 13 percent of women and 10 percent of men over the age of 60 suffer from osteoarthritis of the knee. Introduced in 2001, Durolane—a single-injection hyaluronic acid treatment for knee osteoarthritis—has been tested in more clinical studies than any other hyaluronic therapy on the market.
If you have received a Durolane insurance denial, you have likely tried many other treatments for your knee osteoarthritis and were excited about a treatment that could relieve your chronic knee pain. It’s important that you do not give up after such a denial. The Law Offices of Scott Glovsky helps people just like you every single day. People who have faithfully paid their insurance premiums yet now when they need their insurer to come through, they receive a denial.
What is Durolane and What Is It Used For?
Durolane is longer-lasting than Synvisc-One and longer-lasting than steroid treatments. Chosen by more than a million doctors and patients, Durolane has been clinically proven to match the power of 5-injection therapies for pain relief. Many patients see significant improvements in their quality of life as early as two weeks following a Durolane injection. Durolane has been proven safe while providing longer-lasting pain relief when compared to steroid injections.
Why Claims Associated with Durolane May Be Denied
The most common reasons why medical claims are denied include:
- The treatment was out-of-network
- There are errors in the claim
- No prior authorization was sought
- The claim was filed too late
- The treatment is excluded under the policy
- Incorrect coding of the treatment paperwork
- The treatment is deemed “not medically necessary”
- The insurer considers the treatment “experimental” or “investigational”
While some of the above reasons for claim denials can be fixed and resubmitted, and some may preclude the treatment, when an insurer claims the treatment is investigational, experimental, or not medically necessary, it usually means the company simply doesn’t want to pay for the treatment. The average cost for one syringe of Durolane is $1,260, so if your insurance company has issued a denial, this is the likely reason.
What Can You Do About a Durolane Insurance Denial?
Insurance companies count on the fact that most people are extremely busy and may not have the time or the knowledge necessary to appeal an insurance denial. Because of this, many insurance denials go unchallenged. Attorney Scott Glovsky has been helping people in these situations for many years. Scott has gone up against the biggest health insurance companies in the business on behalf of his clients—and won. You have the right to file an internal appeal where you will resubmit the claim, perhaps with a letter from your doctor detailing why Durolane is necessary to help you with your knee pain. If the internal appeal is not successful, you can then file an external claim in which a neutral third party will look at the facts of your denial and make a decision that the insurer must abide by.
Specific Insurance Companies That Are Known to Deny Durolane
Almost one in every fourteen health insurance claims are initially denied out of hand. While any insurer can deny a health insurance claim, some are more likely than others to do so. In the state of California, you may have received a Durolane insurance denial from one of the following insurance companies:
How Can Osteoarthritis and a Durolane Insurance Denial Affect My Life?
According to the CDC, about one in five U.S. adults who suffer from osteoarthritis experience anxiety and depression. Osteoarthritis of the knee can result in difficulty moving, stiffness, pain, and loss of muscle tone, strength, and stamina. It can also cause fatigue, poor sleep, social isolation, inability to work, financial difficulties, and an overall deterioration in the quality of life. Because these symptoms can be so severe, a Durolane insurance denial can be devastating.
How the Law Offices of Scott Glovsky Can Help with a Durolane Insurance Denial
Following a Durolane insurance denial, you may feel hopeless and overwhelmed by life. When you reach such a low point, you may not know where to turn for help. The Law Offices of Scott Glovsky is ready to take on your insurer and help get you the treatments you need. Attorney Scott Glovsky has spent his entire career going toe-to-toe with uncaring insurance companies. He has learned to be better prepared, more focused, and ready to stand firmly on the just side of an insurance denial. Having worked on the other side early in his career, Scott knows the arguments these big insurers are likely to use and how to exploit their weaknesses. Don’t let a Durolane insurance denial rob you of your hope—contact the Law Offices of Scott Glovsky today.