A relatively new procedure called Intracept is providing those who have suffered from chronic low-back pain some relief. Intracept has garnered FDA approval as the first and only procedure of this type approved by the agency for chronic pain in the lower back. Intracept zeroes in on the nerves responsible for low-back pain via radiofrequency heat. Two of the major benefits of Intracept are that there are no spinal implants involved and there isn’t a lengthy recovery since Intracept is an outpatient procedure.
Clinical studies have shown that 64 percent of patients reported more than 50 percent pain relief, while 30 percent reported complete pain relief within 12 months following the Intracept procedure. Pain in the lower back is experienced by as many as 80 percent of all adults at some point in their lives, while almost a quarter of all adults will develop chronic low-back pain that lasts at least 12 weeks or longer. Unfortunately, having an Intracept procedure denied by your insurance can put an immediate stop to a procedure that could potentially help millions of people.
Why Are Many Intracept Procedures Denied by Insurance?
If your Intracept procedure has been denied by insurance, the reason is likely the cost—although your insurance company will probably use any other excuse than cost (the Intracept procedure can cost from $10,000 to $15,000). Look carefully at your denial letter to determine why your Intracept procedure was denied. You may have failed to obtain prior approval, there could be missing information on your claim, or the insurer may claim that the procedure is “experimental, or investigational.” If the denial is due to missing information, you can re-submit the claim, or you can obtain a letter from your doctor that describes in detail why the procedure is important for your back pain.
What Should You Do if Your Intracept Health Claim is Denied?
If you’ve had an Intracept procedure denied by insurance, you may be feeling frustrated and angry. After all, this is a procedure that could potentially help you get rid of your chronic pain. You do have options, and speaking with an experienced health claim denial attorney can help you through the process. You can file an internal appeal with your health insurer, perhaps including additional details and a letter from your doctor detailing why the Intracept procedure is necessary for your health and your future. If your internal appeal is unsuccessful, your attorney may suggest you file an external appeal where a neutral third party will make a decision on whether your Intracept health claim should be approved. Depending on your particular situation, your attorney may suggest skipping the external appeal and pursing a legal path instead.
What Health Insurers Are Known to Deny an Intracept Procedure?
Although Intracept is a fairly new procedure, Medicare and many insurance plans will cover it so long as the following criteria are met:
- You’ve had chronic low-back pain for at least six months.
- Physical therapy, injections, medications, and other conservative treatments have not significantly reduced your pain.
- Swelling and inflammation are irritating a nerve or nerves in your vertebra (an MRI shows bone marrow lesions).
While an Intracept procedure can be denied by virtually any insurance company, some of the insurers that might deny your claim include:
How Can Your Doctor Help with an Intracept Procedure Denied by Your Insurance?
A letter from your doctor that details all the reasons the Intracept procedure can help relieve your pain better than any other type of procedure can go a long way in convincing your insurance company that it should approve the procedure. Your doctor can explain your medical history of back pain as well as the other interventions you’ve tried that have not been successful. Attorney Scott Glovsky has significant experience helping people just like you who have been frustrated by an insurance company that is not honoring its commitment to you and your health.
What Are the Benefits of the Intracept Procedure?
When conservative treatments have not been successful, Intracept is a viable option. If your lower back pain has been constant for six months or longer and you have exhausted conservative treatments like steroid injections and pain medications, Intracept could offer the relief you’ve been seeking. Intracept is a minimally invasive therapy—a single small incision is made along the spine, then a tiny fluoroscope and cannula access the nerves in the spinal cord.
Smaller incisions are much less traumatic to your body and your health, minimizing the risk of infection and other complications, and ensuring a faster recovery. There are no implants with Intracept—no screws, plates, or electrical implants. A small part of your basivertebral nerve is targeted, heating it up and preventing pain signals from transmitting to your brain. The procedure takes only about 80 minutes and offers long-lasting relief.
How the Law Offices of Scott Glovsky Can Help with an Intracept Procedure Denied by Insurance
If you’ve had an Intracept procedure denied by insurance, attorney Scott Glovsky is ready to help you get the procedure you need for your health approved. Scott understands how insulting and demoralizing it is to discover that the people you’ve paid to protect you are the first ones to turn their backs on you when you need them most. Scott’s goal is to seek justice on your behalf by being a strong advocate who cares about you enough to stay the course. The hard-fought case victories achieved by the Law Offices of Scott Glovsky have positively impacted millions of policyholders by forcing big insurance companies to change their behavior. Contact the Law Offices of Scott Glovsky today.