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Insurance Companies Deny Viscosupplementation for Knee Osteoarthritis

Blog, Insurance and Healthcare Denials, Insurance Bad Faith
Insurance Companies Deny Viscosupplementation for Knee Osteoarthritis

Knee Osteoarthritis is a major cause of disability in this country. It is painful and develops slowly over time. While osteoarthritis has no cure, viscosupplementation can be very effective in treating it and allowing patients to be active and reduce pain. The treatment involves injecting a fluid called hyaluronic acid into the knee to act as a lubricant to aid movement and limit pain.

Health insurance companies such as Anthem Blue Cross of California, Blue Shield of California, Kaiser, Health Net, and Aetna may deny authorization and coverage for viscosupplementation for knee osteoarthritis on the ground that it is not medically necessary. Like many new treatments, especially expensive treatments, health insurance companies often deny coverage regardless of the fact that the treatment can be very effective and has shown promising results. To obtain coverage from some insurance companies, a patient must show positive results from prior treatments and other treatment options must be failing to effectively reduce the symptoms of osteoarthritis. Insurance companies often use the second requirement to deny treatment as not being medically necessary.  They claim that standard options have not been exhausted. However, they often refuse to acknowledge how many patients actually qualify for the treatment and how viscosupplementation could greatly increase their quality of life. It has been shown to reduce pain and delay the need for total knee arthroplasty, which is a total knee replacement, thus improving quality of life.