Employed by Insurance Companies

[BloodySurgeon]

Receiving lots of denials from insurance companies. Getting worst each year.

Genicular nerve blocks as well as other procedures determined to be experimental in my area as per insurance company based on their 5 minute “UpToDate search”

Even performing an epidural steroid injection for a nerve impingement secondary to epidural scarring following a laminectomy. They will approve a repeat surgery though…

Are others having difficulty as well? They are cutting reimbursement left and right including anesthesia sedation. Are we going to be forced as a specialty to perform procedures out of pocket in the future to avoid insurance issues?

Do we have to include regenerative medicine or similar therapies to just stay afloat? Any thoughts?

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[jsaul]

The insurance companies are more afraid of the orthopedic surgeon than they are afraid of you. That is why the can fuse the spine to their wallet's content and scope the meniscus left and right to no end

 

[deleted131481]

The insurance companies are more afraid of the orthopedic surgeon than they are afraid of you. That is why the can fuse the spine to their wallet's content and scope the meniscus left and right to no end

Do they just have better lobbies?

 

[crunchymedicine]

Do they just have better lobbies?

Yes, and it also seems that there is more collegiality in their specialty than pain.

 

[TheLoneWolf]

The insurance companies are more afraid of the orthopedic surgeon than they are afraid of you. That is why the can fuse the spine to their wallet's content and scope the meniscus left and right to no end

Really? Our orthopedic surgeons said that arthroscopic surgeries volumes are down after the sham surgery vs true arthroscopic surgery papers came out. Same thing, insurance denials.

 

[drrosenrosen]

 

[Pain Applicant1]

That's really funny but those are good points he's making. I never thought about it like that.

 

[drrosenrosen]

That's really funny but those are good points he's making. I never thought about it like that.

Sad but true

 

[buddababa]

Just got a denial from evicore for an epidural because no advanced imaging in 24 months. Last images was 25 months. No change in sx etc. Just ridiculous. I told the doctor. C'mon man (send in the sportscenter voice). Utterly ridiculous.

 

[mid|ine]

Just got a denial from evicore for an epidural because no advanced imaging in 24 months. Last images was 25 months. No change in sx etc. Just ridiculous. I told the doctor. C'mon man (send in the sportscenter voice). Utterly ridiculous.

Then you order the required MRI and they deny it, because there are no change in sx... lol, been down that road more then once

 

[buddababa]

Then you order the required MRI and they deny it, because there are no change in sx... lol, been down that road more then once

Haha, yes. Its just this year, I've seen it drastically get worse than in previous years.

 

[Ferrismonk]

Then you order the required MRI and they deny it, because there are no change in sx... lol, been down that road more then once

and they'll require 6 weeks of PT in the last 6 months as well before considering a new MRI

 

[Ducttape]

or worse yet, they will require you have tried an epidural injection prior to approving the new MRI - that you had to order to get the epidural....

 

[RoloTomassi]

or worse yet, they will require you have tried an epidural injection prior to approving the new MRI - that you had to order to get the epidural....

 

[bedrock]

I was an an honest man before I had to start dealing with dishonest insurance companies, 😉.

 

[hyperalgesia]

In my area EVERY spine procedure, including LESI and fusion, etc, require preauth and have rigorous and evolving exclusion criteria, roadblocks, etc.

If spine surgery has not been hit in your area yet, it's a matter of time.

The only thing that saves anyone is an extremely low volume of cases in a coverage area so the cpt codes don't show up as targets in the executive mtgs.

If you're in an underserved area with a bunch of insurance companies and only ONE doc of a particular specialty, it's gonna be a good situation all around for the doc.

 

[Welcome123]

or worse yet, they will require you have tried an epidural injection prior to approving the new MRI - that you had to order to get the epidural....

I have actually seen that as a requirement with some carriers