Orthovisc Insurance Denial

Page Contents:

• What is Orthovisc?
• Who Needs Orthovisc?
• Why Do Insurance Companies Deny Orthovisc?
• What Are Your Legal Rights to Orthovisc?
• How the Law Offices of Scott Glovsky Represent Orthovisc Insurance Denials

Orthovisc is a hyaluronate used in a procedure known as viscosupplementation. The drug is a thick solution of highly purified sodium hyaluronate in saline. Hyaluronan is found in the human body. This substance lubricates our joints, acting as a shock absorber. The natural hyaluronan in the human body is usually compromised among those who have osteoarthritis. Orthovisc is injected directly into the knee or hip joint to restore the cushioning and lubricating properties that are normally present in the knee joints but can be absent or decreased in those with arthritis.

Orthovisc gained FDA approval in 2004 for those who did not achieve adequate relief from more conservative treatments like acetaminophen. Interestingly, Orthovisc is considered a medical device, rather than a drug, and is administered in 3-4 weekly intra-articular injections. The treatment can provide pain relief for those with arthritis for up to 26 weeks. If you’ve received an Orthovisc insurance denial from your insurance carrier, you could benefit from speaking to an insurance denial attorney from the Law Offices of Scott Glovsky.

Those with knee pain, hip pain, or osteoarthritis can benefit from Orthovisc injections. Athletes, “weekend warriors,” and those who have spent many years of work standing on their feet may see degeneration of cartilage and tissue within the knee and hip joints. What begins as a subtle discomfort, can eventually turn into severe pain. Orthovisc injections cannot reverse symptoms of osteoarthritis, but they can help reduce pain and inflammation.

Orthovisc is generally prescribed for those whose pain has failed to respond to more conservative approaches. These injections can be an alternative to knee surgery or relief from the chronic pain of osteoarthritis or injury. Viscosupplementation works by artificially supplementing the fluid in the joint, giving it extra lubrication and cushioning, and can slow the progression of arthritis.

The average cost of Orthovisc injections is $2,154. Unfortunately, insurers may issue Orthovisc insurance denials based on the belief that the drug is not medically necessary—which generally means it costs more than the insurer wants to pay. Because of this, Orthovisc might not be on the insurer’s formulary list. Paradoxically, many insurers will pay for knee replacement surgery (which can cost as much as $50,000), while balking at paying for Orthovisc injections.

If you have received an Orthovisc insurance denial, you may be unsure of what you need to do in order to get the medical treatment you need. Your insurance company has an obligation to provide you with the medical treatments your doctor believes you need. Your doctor can provide a letter that details why Orthovisc is medically necessary for your arthritis pain. If this letter fails to work, you can file an appeal with your insurance company. Having a strong legal advocate who has extensive experience in insurance denials can make a real difference in the outcome. 

Trying to get your prescription medication approved by your health insurance company can be a frustrating experience following an Orthovisc insurance denial. Attorney Scott Glovsky is a Los Angeles prescription drug denial lawyer who can help you through this difficult time. Scott is highly experienced regarding how California insurance laws apply in these circumstances. Scott has a passion for helping insured individuals along with significant knowledge of insurance law. Contact the Law Offices of Scott Glovsky today.