What is Radiofrequency Ablation (RFA)?
Radiofrequency ablation (RFA) is a medical treatment used to alleviate pain through heat that destroys tissue. A precisely placed needle uses radio waves to heat an area of a specific nerve. In turn, pain signals are prevented from being sent back to the brain. Radiofrequency ablation is most often used for lower back pain, neck pain, and arthritic joints that suffer from long-term pain issues when other pain management treatments have not worked. Other types of pain that can be helped with RFA include:
- Pain associated with cancer
- Peripheral nerve pain
- Trigeminal neuralgia that causes facial pain
- Chronic pain caused by arthritis of the spine (spondylosis)
- Sacroiliac joint pain
- Knee pain
- Heart rhythm problems
Although RFA can be a true godsend for many, you may wonder what to do if your insurance company won’t approve radiofrequency ablation treatments for your pain.
Is Radiofrequency Ablation Medically Necessary?
Chronic pain can be debilitating, significantly changing the way you live your day-to-day life. There are many treatments for pain, from aspirin to invasive surgery, and many treatments in between, including joint injections, nerve blocks, and ablations. Ablations, injections, and blocks can provide at least 50 percent pain relief for months at a time, helping many people avoid a surgical procedure.
Those who have had nerve pain for three months and have tried conservative treatments such as prescription medications (gabapentin, pregabalin, duloxetine), over-the-counter pain relievers, and physical therapy are often good candidates for radiofrequency ablation. The best candidates are motivated and willing to undergo trial and error to determine exactly which nerve (or nerves) are communicating pain.
Does Insurance Cover Radiofrequency Ablation?
While many insurers do cover radiofrequency ablation, there are often specific conditions that must be met. Radiofrequency ablation for facet joint pain (if conditions are satisfied) is more likely to be covered than the same treatment for other types of pain. Generally speaking, you must have a history of at least three months of moderate to severe pain that has not responded to conservative treatments and causes functional impairment. It must be clear there is no non-facet joint pathology that could explain your pain, such as an infection, a fracture, or a tumor. A clinical assessment must clearly implicate the facet joint as the source of pain, and all pre-procedural documentation must be in order.
Why are Claims for Radiofrequency Ablation Denied?
Although radiofrequency ablation is considered a medically necessary procedure in many cases, the treatment can still be denied. Some insurers still consider radiofrequency ablation to be “investigational” or “experimental.” Further, because the treatment usually only lasts for months at a time, some insurers are more likely to approve surgery to alleviate the pain than RFA. Without prior authorization, medical claims for radiofrequency ablation could be denied, leaving you responsible for the charges.
What Should You Do if Your Coverage for Radiofrequency Ablation is Denied?
If your medical coverage for radiofrequency ablation is denied, it is important that you speak to an experienced radiofrequency ablation insurance denial attorney from the Law Offices of Scott Glovsky as quickly as possible. The insurer may deny the claim because it believes it is not medically necessary, or because it believes the treatment is still relatively experimental. Having a strong legal advocate who will stand up for you and your health, fighting for the medical treatments you need, is crucial following a radiofrequency ablation insurance denial.
What Insurance Companies May Be More Likely to Deny Radiofrequency Ablation?
Virtually any insurance company may choose to deny your treatment for radiofrequency ablation. Your insurance company may require prior approval before having the procedure done or may deny it for the reasons listed above. If your physician feels this treatment is your best option for pain relief, then your radiofrequency ablation insurance denial attorney may need to go toe-to-toe with your insurer. Anthem Blue Cross, Blue Shield, Health Net, Kaiser, UnitedHealthcare, Aetna, or other insurers may deny your RFA claim. Don’t give up—contact the Law Offices of Scott Glovsky.
How the Law Offices of Scott Glovsky Can Help
When your insurance company won’t approve radiofrequency ablation, it’s time to call attorney Scott Glovsky. Scott fights against big corporations that think they’re untouchable. He and his legal team fight for people just like you, when the situation seems impossible. When you suffer from chronic pain, yet your insurance company is telling you it won’t approve RFA—a treatment your doctor feels is appropriate for your pain—it can be frustrating. When you choose the Law Offices of Scott Glovsky, you are no longer in the fight alone. Attorney Scott Glovsky will be fully committed to your case as he fights for justice on your behalf. Contact the Law Offices of Scott Glovsky today.