United Health Care Denials for PNS Trials and Implants

[drusso]

They're saying it's experimental. Anyone else seeing this?

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[Taus]

but what about the cluneal neuralgia epidemic!!! Almost as prevalent as the surge in vertebrogenic lbp….

 

[drusso]

but what about the cluneal neuralgia epidemic!!! Almost as prevalent as the surge in vertebrogenic lbp….

Cluneal neuralgia is also shaping up to be a serious public health issue too. I’m also seeing cases of “long cluneal neuralgia” status post SIJ fusion. We’re fortunate to live in a time of great medical advances for neuropathic pain. #opioidsparing #patientcenteredcare #outcomesmatter

 

[JelloIsJigglin]

i assume united denies everything at this point.

 

[pmrmd]

I’m very apprehensive about PNS in anyone now, especially patients with insurances that do post-procedure reviews and will look for any excuse not to pay the bill after the patient received the hardware.

 

[painfree23]

i assume united denies everything at this point.

Have u seen their stock price? They definitely do.

 

[Pain_doc]

They deny everything they possibly can, especially as you roll in their medicare advantage plans. PNS, vertfilex, MILD, geniculate RFA, SIJ RFA, SCS for anyone without post-lami or CRPS..the list will continue to grow. All under the guise of experimental or ''plan does not cover''. Although uhc is the worst, the other carriers are expanding their denials as well. In talking to one doc for a peer to peer, the doc said the insurer excludes coverage for these procedures so denial can't be overturned on appeal through peer to peer. Of course you can submit a written appeal.

 

[jsaul]

Even when you have pre Auth. They still deny paying after . And then you spend time appealing and they deny that too
Uhc Is the worst .

 

[painfree23]

Even when you have pre Auth. They still deny paying after . And then you spend time appealing and they deny that too
Uhc Is the worst .

Yup, pre auth doesn’t tell u if a code is billable…found that out the hard way with occipital nerve blocks.

 

[soccrwz]

Yup, pre auth doesn’t tell u if a code is billable…found that out the hard way with occipital nerve blocks.

What about prefer/pre D?

 

[GlowInTheDark]

United will refuse to pain for IDDS meds when refills are due. They’re terrible.

 

[Status Sciaticus]

lol how are they still getting people to buy their insurance?

 

[gaspasser127]

I’ve been hearing about these “prior auth not required” followed by post-procedure denials a lot recently. Why not just deny the procedure beforehand? What financial benefit do they get by having the patient get stuck with the bill? Either way they wouldn’t pay for the procedure right?

 

[Agast]

I’ve been hearing about these “prior auth not required” followed by post-procedure denials a lot recently. Why not just deny the procedure beforehand? What financial benefit do they get by having the patient get stuck with the bill? Either way they wouldn’t pay for the procedure right?

“Prior authorization not required” is a trap. When that happens, I submit for a pre-determination - that’s when we discover something is on the roster as “experimental.”

Pre-determination means your case is reviewed and they promise to pay for it

Referral, predetermination, authorization, precertification: What's the difference?

Probably one of the trickiest parts of any physician practice administratively is understanding and effectively navigating insurance prior authorization requirements.

www.mgma.com

I reflexively submit for pre-D for genicular and SI joint RFA, and all implants or procedures that utilize expensive supplies