Nerve block injections are used prior to some surgical procedures and can also be used to manage the pain of chronic health conditions or injuries that have damaged, irritated, or inflamed nerves. Managing pain that comes from the spine, neck, legs, arms, or buttocks can be an important function of nerve blocks, so having a nerve block injection denied by insurance can be debilitating. It can be extremely helpful for you to have an experienced attorney like Scott Glovsky by your side following an insurance denial. When your health and your future are at stake, Scott Glovsky will be the advocate in your corner who will fight for you every step of the way.
Reasons Why a Nerve Block Injection Denied by Insurance Could Occur
According to Medical Coverage Guidelines, while approval or denial of your nerve block injection will depend on your individual circumstances and your specific insurer, generally speaking, nerve block injections are approved for complex regional pain syndrome, Morton’s Neuroma, and certain other peripheral nerve blocks. The following conditions may not be approved for nerve block injections as the treatment may still be considered experimental, investigational, or not medically necessary by your insurer:
- Ganglion impar blocks of the sacrococcygeal joint
- Occipital neuralgia and headaches
- Occipital neuralgia
- Diabetic neuropathy
- Chronic knee pain
- Hardware injection or blocks for post-surgical or other spine pain
Even if your particular health condition is listed above, that does not mean that you are ineligible for a nerve block injection or that attorney Scott Glovsky cannot help persuade your insurer to cover those treatments. If a first nerve block injection is approved, repeat blocks are usually considered medically necessary if you’ve had a 50 percent reduction in pain for at least 6-8 weeks.
What Should You Do if Your Health Claim for a Nerve Block Injection is Denied?
A nerve block injection denied by insurance can feel devastating, but you do have options. First, you will need to look at your denial letter carefully to see why your claim was denied. Claims are often denied because of a simple, fixable mistake. If this is the case, you can fix the mistake or send additional information to your insurer. If your insurance company is claiming your nerve block injection is not medically necessary or is experimental or investigational, you need a strong advocate in your corner who is not afraid to go toe-to-toe with a big insurance company. Attorney Scott Glovsky can help you file an internal appeal, and if that appeal is unsuccessful, he will recommend either filing an external appeal with a neutral third party or taking a legal route.
Are Some Health Insurance Companies More Likely to Deny Nerve Block Injections?
Any insurance company may deny a nerve block injection claim, but some may be more likely to do so. An insurer can save hundreds of thousands—even millions—of dollars by rejecting these claims out of hand because very few policyholders appeal such a decision. Many people believe that if their insurance company denies a claim for treatment, that is the end of the issue. This is simply not true, and as many as half of all those who do appeal a claim denial will have that denial reversed. California insurers who may deny your nerve block injection include:
What is the Cost of a Nerve Block Injection?
A nerve block injection can cost as much as $5,000. Since most nerve block injections are repeated three to six times over the course of a year, the cost is what many insurance companies base their denial on. While your insurer may cloak a denial behind language like “experimental,” or claim the nerve block injection is “not medically necessary,” those who have suffered chronic pain over a long period of time likely feel much differently about such a denial.
Can Your Doctor Help You Get Your Nerve Block Injection Denial Reversed?
Your doctor can be an important component in your quest to have your nerve block injection denial reversed. Your doctor can write a letter to your insurance company that details all the reasons you will benefit from having a nerve block injection. Your doctor may also engage in a peer-to-peer telephone call with an individual who represents your insurance company. Since your doctor knows your medical history and has the best insights as to why you would benefit from a nerve block injection, the doctor’s opinion is important.
How the Law Offices of Scott Glovsky Can Help with Your Nerve Block Injection Denied by Insurance
A nerve block injection denied by insurance can leave you struggling with your pain and frustrated with your insurer and the situation. Attorney Scott Glovsky can help. Scott understands your situation while also understanding every single tactic and trick a big insurer can implement to deny your claim. Scott is ready for even the toughest battle and will not allow your insurer to tear you down or blame you for your current situation. When you need help navigating the appeal process, contact the Law Offices of Scott Glovsky.