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.