How are Steroid Injections Used for Pain Management?
Hormones normally produced by the adrenal glands (two small glands above the kidneys) can be mimicked by steroid injections. Redness and inflammation can be significantly reduced when steroids are injected into a joint or muscle, relieving pain and stiffness. Steroids can also be injected into the blood, reducing inflammation throughout the body.
When steroids are injected into the blood, they also reduce the body’s normal immune system activity which can help treat autoimmune conditions that are the result of the immune system mistakenly attacking the body. Essentially, when inflammation is reduced in the body, pain is also reduced. So, while steroid injections cannot treat the underlying cause of specific conditions, they can treat the symptoms, making the condition easier to live with.
For these reasons, steroid injections are given for many types of pain including multiple sclerosis pain, arthritis pain, back pain, osteoarthritis pain, vertebrae disc pain, peripheral neuropathy pain, and more.
Have You Received a Steroid Injections Insurance Denial?
While most health insurance plans will cover at least a portion of the cost of a cortisone shot, coverage will depend on how many shots you need, and whether or not the insurer deems your steroid injections “medically necessary.” Cortisone shots that are not covered by insurance can cost from $150 to $300 each, while PRP (Platelet-rich plasma injections) can cost from $500-$1,500, depending on where you live. The retail price for a Zilretta steroid injection that lasts for 3 months is about $784.11 for a single 32 mg Suspension Reconstituted ER. If you have received a steroid injection insurance denial, you do have recourse, largely filing an internal appeal and then an external appeal if your internal appeal is denied.
Why Might Your Steroid Injections Claim Be Denied?
Unfortunately, many insurance companies are still wrongly denying steroid injection claims on the theory that they are “experimental, investigational, or not medically necessary.” Except for epidural steroid injections, most steroid injections are FDA-approved and should be considered medically necessary.
There has been some controversy regarding epidural (spinal) steroid injections. Currently, Medicare limits epidural steroid injections to a maximum of four sessions per spinal region during any 12 months, and these injections are not considered medically reasonable and necessary for more than one spinal region to be injected during the same session.
Epidural steroid injections—as well as other types of steroid injections—are often considered “second-line” therapies, only approved for patients who fail conservative treatments. Unfortunately, these “conservative” treatments generally include opioid prescriptions to manage the pain. While opioids may help manage pain, they can also be extremely addictive and can cause many people to feel drowsy and “foggy.”
If your steroid injection insurance denial is based on a simple mistake, you can provide the necessary information or correct the mistake and re-submit the claim to your insurer. Insurance companies often use “experimental, investigational, and not medically necessary” wording to deny legitimate insurance claims. If this is the case, you will be required to file an internal appeal, and perhaps an external appeal as well.
What Should You Do Following a Steroid Injections Insurance Denial?
If you have received a steroid injection insurance denial, you should speak to a knowledgeable insurance denial attorney like Scott Glovsky. Scott can guide you through the appeals process in the easiest, best way possible. You may first obtain a letter from your doctor that states the medical reasons steroid injections are necessary to treat your specific issue. This letter can be a part of your internal appeal. An internal appeal asks the insurance company to take another look at your claim and reconsider its initial denial.
If your internal appeal is denied, you have the right to file an external appeal with a neutral third party who will decide whether your steroid injections are medically necessary. The decision of this third party is legally binding for your insurance company. There is a very compelling reason for pursuing an appeal following a steroid injection insurance denial. According to jdrf.org, more than 50 percent of insurance appeals are ultimately successful and can be even higher if you have an employer plan that is self-insured. That said, we highly recommend speaking with Scott before you do. This is because it may be beneficial to take legal action after an internal denial instead of filing an external appeal. Every situation is different, and Scott can evaluate your specific facts.
What Specific Insurance Companies May Issue a Claim Denial for Steroid Injections?
While any insurance company can issue a steroid injection insurance denial, some insurers are more likely to do so than others. California health insurers who could potentially deny necessary steroid injections include:
What Types of Steroid Injections Are Commonly Denied?
Because of the controversies surrounding epidural steroid injections, this type of injection is often denied. If your doctor feels an epidural steroid injection is the best treatment for your back pain, you may be required to file an internal appeal and potentially an external appeal as well. Some health insurance companies are also known to consider therapeutic steroid facet injections as “experimental, investigational, or not medically necessary.” Your doctor may need to explain why the steroid injection is medically necessary to control your pain.
How the Law Offices of Scott Glovsky Can Help with Steroid Injections Insurance Denial
Attorney Scott Glovsky understands how devastating it can be to receive a steroid injection insurance denial, particularly when that treatment may be your best option for controlling pain. Scott believes strongly that insurance companies have an obligation to protect you and your family. After all, you have faithfully paid your insurance premiums and deserve an insurer who cares about you, your health, and your family.
If your insurance company has fallen short of providing the support you need and deserve, the Law Offices of Scott Glovsky will fight for justice on your behalf. Far too many large insurance companies think they are untouchable. Scott Glovsky never hesitates to take on these big corporations, fighting for justice on behalf of his clients. Contact the Law Offices of Scott Glovsky today.