Understanding Pain
Diagnosis & Understanding
4. Neck Pain
1:55
6. Painful Diabetic Neuropathy
1:46
8. Foot Pain
1:50
9. Ankle and Foot Pain
1:46
10. Cancer Pain
1:34
Non-Surgical Treatment Options
2. Bracing
1:30
3. Acupuncture
2:13
4. Physical Therapy
1:35
5. Cognitive Behavioral Therapy
2:08
Minimally Invasive & Surgical Treatments
2. Regenerative Medicine
2:06
5. Caudal Epidural
1:33
10. Sacroiliac Joint Fusion
1:39
11. Kyphoplasty and Vertebroplasty
2:05
12. Basivertebral Nerve Ablation
1:36
13. MILD Procedure
2:04
14. Spinal Decompression Surgeries
1:41
15. Artificial Disc Replacement
1:52
SI Joint Dysfunction
Diagnosis & Understanding
3. Sacroiliac Joint Dysfunction
1:55
4. Pseudosciatica
1:48
5. SI Joint Injection
1:49
Non-Surgical Treatment Options
1. Physical Therapy
1:35
2. Cognitive Behavioral Therapy
2:08
3. Bracing
1:30
6. Regenerative Medicine
2:06
Spinal Cord Stimulation (SCS)
Diagnosis & Understanding
11. Painful Diabetic Neuropathy
1:46
12. CRPS I
1:57
13. Central Sensitization Syndrome
1:48
14. Neck Pain
1:55
Non-Surgical Treatment Options
1. Physical Therapy
1:35
2. Cognitive Behavioral Therapy
2:08
3. Bracing
1:30
Minimally Invasive & Surgical Treatments
3. Stellate Ganglion Injection
1:52
4. Lumbar Sympathetic Injection
1:36
Peripheral Nerve Stimulation (PNS)
Diagnosis & Understanding
3. CRPS I
1:57
5. Nerve Blocks
2:07
6. Nerve Blocks
2:07
7. EMG Nerve Conduction Study
1:26
Minimally Invasive & Surgical Treatments
1. Hydrodissection
1:33
Alternative & Emerging Therapies
3. Regenerative Medicine
2:06
Minimally Invasive Lumbar Decompression (MILD)
Diagnosis & Understanding
3. MILD Procedure
2:04
Minimally Invasive & Surgical Treatments
6. Artificial Disc Replacement
1:52
7. Facet Joint Fusion
1:48
8. Regenerative Medicine
2:06
Diabetic Neuropathy SCS
Diagnosis & Understanding
1. Painful Diabetic Neuropathy
1:46
Non-Surgical Treatment Options
Minimally Invasive & Surgical Treatments
1. Peripheral Nerve Stimulation
1:41
Alternative & Emerging Therapies
1. Regenerative Medicine
2:06
Interspinous Fusion (midline or lateral approach)
Diagnosis & Understanding
Non-Surgical Treatment Options
3. Bracing
1:30
Alternative & Emerging Therapies
Dorsal Root Ganglion Stimulation (DRG)
Diagnosis & Understanding
3. Pelvic and Perineal Pain
1:52
7. Painful Diabetic Neuropathy
1:46
8. CRPS I
1:57
Non-Surgical Treatment Options
1. Physical Therapy
1:35
2. Cognitive Behavioral Therapy
2:08
3. Bracing
1:30
Minimally Invasive & Surgical Treatments
3. Lumbar Sympathetic Injection
1:36
Alternative & Emerging Therapies
3. Regenerative Medicine
2:06
Robert Moghim MD
Anchor Healthcare
Insurance Rules and Why it Matters to you
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Insurance Rules and Why They Matter to You
When it comes to medical treatments, insurance companies play a big role in deciding what steps must be taken before approving certain procedures. This process, called step therapy or prior authorization, means that insurance may require you to try specific treatments—like bracing, physical therapy, or medications—before approving more advanced options.
For example, if you have chronic back pain and your doctor recommends radiofrequency ablation (RFA), your insurance will likely require two separate diagnostic medial branch blocks first. These are temporary nerve-numbing injections used to confirm that the pain is coming from the facet joints. If both blocks provide significant but short-term relief, then insurance will approve RFA, which provides longer-lasting pain reduction.
Another common example is knee pain. If your doctor recommends an injection, insurance may require you to complete a round of physical therapy or wear a brace for a set period of time before approving it.
While this process helps insurance providers control costs, it can sometimes slow down access to the treatment you need. That’s why it’s important to follow the required steps and document your progress. If a treatment isn’t working, your doctor can use that information to move you to the next approved step.
FAQs
How do insurance rules impact the treatment process for knee pain?
Insurance rules might require patients to engage in conservative treatments like physical therapy or using a brace for a specified period before approving advanced treatments such as injections for knee pain. This can control costs and ensure that all alternatives are attempted prior to more invasive or expensive options.
What can I do if the initial treatment steps required by insurance are not effective?
If the initial treatments required by insurance, like physical therapy or bracing, are not effective, it's crucial to document your progress and communicate this with your doctor. This documentation allows your doctor to provide evidence to the insurance company that those treatments are not beneficial and to seek approval for the next step in the treatment plan.
What is step therapy in the context of insurance rules?
Step therapy is a cost-controlling process employed by insurance companies that requires patients to try certain, often less expensive, treatments before they approve more advanced procedures. This can involve trying physical therapy, medications, or specific diagnostic steps prior to receiving approval for more definitive treatments.
Why is it important to follow insurance required treatment steps?
Following the required treatment steps set by insurance is important because it ensures you are working within their guidelines to eventually receive coverage for the needed advanced treatments. Additionally, documenting each step can help facilitate quicker approval for the subsequent step if the initial treatments do not provide sufficient relief.
Why might my insurance require diagnostic medial branch blocks before approving radiofrequency ablation (RFA) for back pain?
Insurance companies often require diagnostic medial branch blocks to confirm the exact source of back pain before approving radiofrequency ablation (RFA). These temporary nerve-numbing injections ensure that the pain is coming from the facet joints, which helps justify the need for the more advanced, longer-lasting RFA procedure.