Legally reviewed by Scott Glovsky , Trial Attorney & Founder
According to the American Family Physician, knee pain affects about one-quarter of all adults. The prevalence of chronic knee pain has increased nearly 65 percent over the past two decades and now accounts for nearly four million primary care visits each year. Older adults are more likely to experience knee pain, and when ignored, knee pain can result in severe outcomes and disabilities that reduce mobility in all aspects of life. Knee pain can be the result of osteoarthritis, physical injury or trauma to the knee, dislocation, sports injuries, infectious diseases like cellulitis, obesity, compression, a fall, excessive stress on the knee joint, gout, cartilage rupture, or another type of accident.
Because knee pain can definitely affect your quality of life, it is important that you receive the medical treatments your doctor feels will help you. This is why receiving a knee pain treatment insurance denial can be so distressing. If you find yourself in this position, you need a strong legal advocate who will fight for you every step of the way—someone who truly cares about you, your health, your pain, your family, and your future. The Law Offices of Scott Glovsky is ready to help you through this difficult time in the best way possible.
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Typical Knee Pain Treatments
Your treatment or treatments for knee pain will depend on the cause of the pain. If you have a minor injury to your knee, your doctor may have you apply ice packs every hour for 15-20 minutes the first day after your injury. On the second day, you can apply ice packs every three to four hours. Your physician may recommend a compression bandage to help reduce blood flow to the injured knee, thus reducing swelling. You may be asked to keep your knee elevated above heart level and to stop the physical activity that initially caused the injury and pain.
Chronic knee pain could be treated with:
- Medications that treat knee pain, including over-the-counter NSAIDs as well as prescription drugs like diclofenac, which is the strongest, most effective non-steroidal anti-inflammatory drug on the market and is sold under brand names like Zorvolex, Zipsor, Cambia, and Cataflam.
- Synvisc, Monovisc, Euflexxa, Orthovisc, Durolane, and other Vicosupplements —treatments that lubricate and cushion the knee joint, relieving pain and inflammation.
- Radiofrequency ablation
- Steroid shots in the knee area—a cortisone steroid shot can relieve knee pain for a few weeks, or possibly even a few months. Those with chronic inflammation of the knee may notice the symptoms returning over time.
- Osteoarthritis gene therapy drugs like Tanezumab, Sprifermin, Ampion, Fasinumab, Invossa, and oral Disodium Zoledronate Tetrahydrate.
- Physical therapy
- Rheumatoid arthritis medications like Rheumatrex, Trexall, Plaquenil, Azulfidine, Arava, Enbrel, Humira, and Remicade
- Nerve block injections
- Supartz injection
- Knee surgery to repair a damaged bone fracture or ligament, or if you have severe arthritis. Knee arthroscopy is the most common type of knee surgery; after the surgeon sees the damage to your knee, the decision may be to replace your knee joint with an artificial implant.
Why Claims Associated with Knee Pain Treatments May Be Denied
A knee pain treatment insurance denial can occur for many different reasons. The claim may have been incorrectly coded or may not have sufficient information about the treatment. You may have used an out-of-network provider, or the prescribed treatment may be specifically excluded from your healthcare plan.
However, when your insurer denies a treatment by saying it is “not medically necessary,” “experimental” or “investigational,” there is a strong likelihood that the treatment is pricey, and the insurance company simply does not want to pay for it. As an example, the cost of knee replacement surgery is about $35,000.
Some of the newer drugs are also expensive; gene therapy drugs like Invossa can cost as much as $1 million dollars, while Humira can cost almost $8,000 for two doses. Whatever the reason for your knee pain treatment insurance denial, attorney Scott Glovsky is ready to help turn a denial into an approval.
What Can You Do About a Knee Pain Treatment Insurance Denial?
Scott Glovsky and his legal team may start with a letter from your doctor that details how important the specific treatment is for your knee pain. If this does not result in a reversal of the denial, an internal appeal can be filed. An internal appeal asks the insurance company to reconsider its decision. If the internal appeal is unsuccessful, an external appeal with a neutral third party can be filed. This appeal is binding to the insurance company, so if the external appeal is found in your favor, your insurance company will have to approve the knee pain treatment it previously denied.
Specific Insurance Companies That Are Known to Deny Knee Pain Treatments
According to a 2023 PBS report, even when patients receive care from in-network physicians, some 17 percent of claims are denied, with one insurer denying a staggering 49 percent of claims in 2021. Any insurance company can issue a knee pain treatment insurance denial however, some are more likely to do so than others. This same study found that despite the potentially dire impact a denial can have on a patient’s health and finances, only about one in every 500 denials are appealed. Some of these denials deny not only the medically accepted standard of care but also human logic. California health insurance companies that could issue a knee pain treatment insurance denial include:
- Anthem Blue Cross
- Blue Shield
- Kaiser
- UnitedHealthcare
- Aetna
- and others
How Knee Pain Can Affect Your Life
Chronic knee pain can color every aspect of your life. You may lose all your enjoyment of life and be unable to accomplish normal, everyday tasks. The loss of mobility and chronic pain may render you unable to work and make a living, and sleep may be elusive. As a result, you could also suffer from depression, anxiety, and other types of mental disorders. Having attorney Scott Glovsky on your side can help you get the treatments you need for your knee pain.
How the Law Offices of Scott Glovsky Can Help with a Knee Pain Treatment Insurance Denial
Following a knee pain treatment insurance denial, you may feel totally demoralized when you realize that the company you have paid to protect you has now turned its back on you. It is important that you do not give up. You don’t need an army of lawyers to fight the insurance company, you simply need one person who cares enough about you and your future to fight on your behalf. Attorney Scott Glovsky is that person. Scott and his legal team have helped many people over the years turn an insurance denial around. Our hard-fought victories have impacted millions of policyholders by forcing insurance companies to change their behavior and approve necessary treatments. Contact the Law Offices of Scott Glovsky today!
