United & Cervicogenic Headaches/Occipital Neuralgia

[Tenesma]

United's policy on cervicogenic headaches indicates that Cervical RF for cervicogenic Headaches and Occipital Blocks for Occipital Headaches are unproven and not covered.... argh...

---

Members don't see this ad.

 

[PMR 4 MSK]

United's policy on cervicogenic headaches indicates that Cervical RF for cervicogenic Headaches and Occipital Blocks for Occipital Headaches are unproven and not covered.... argh...

Are they proven?

If you hit the GON with lido, it'll be numb for a few hours. I don't know of any study showing the addition of steriod makes it better.

 

[Mister Mxyzptlk]

I have been down this road with cigna. They cite a study showing "only" a few months of relief. How long does a triptan last and what does it cost? One would think a shot that lasts 4 months would be worth several doses of triptans per week.

I send them to ER for severe headaches. The cost of one ER visit is more than a year's worth of ONBs. Maybe some day they will get it.

 

[drusso]

There is only more of this to come. IPM is going to be a boutique specialty service available to private pay patients and those with "Cadillac" Insurance.

 

[Tenesma]

the denial has nothing to do with steroids - they don't pay for any type of injection including diagnostic injections

 

[SleepIsGood]

what about occipital nerve stims? since these are implanted, they work for a longer period of time....do insurance companies harass you guys for them?

 

[jsaul]

what about occipital nerve stims? since these are implanted, they work for a longer period of time....do insurance companies harass you guys for them?

yes they do. you spend more time arguing back and forth and then they end up denying it.

Rf's are denied. SI jt injections are denied.

get paid virtually nothing for esi's.

All while getting yelled at by patients and referring doctors.

Why oh why

 

[Tenesma]

occipital stims are specifically denied under the policy i quoted above...

 

[SleepIsGood]

yes they do. you spend more time arguing back and forth and then they end up denying it.

Rf's are denied. SI jt injections are denied.

get paid virtually nothing for esi's.

All while getting yelled at by patients and referring doctors.

Why oh why

dont say this...lol...i 'm going to be starting my pain fellowship next year 😡

 

[Jcm800]

dont say this...lol...i 'm going to be starting my pain fellowship next year 😡

So what you are saying is you've got 8 months to find another career...i recommend a subway franchise...

 

[pmrmd]

the denial has nothing to do with steroids - they don't pay for any type of injection including diagnostic injections

UHC pays for my cervical injections every day no problem. are you really getting denied for everything or are you exaggerating?

 

[Jcm800]

UHC pays for my cervical injections every day no problem. are you really getting denied for everything or are you exaggerating?

i think he means they dont pay for any type of occipital injection, diagnostic or otherwise. And that they dont pay for the RF, they do pay for medial branches and for ESIs, i agree...

but i just went back and checked my UHC for 64405 and 64626/7 it looks like i have only done a handfull in the last 1 year them (i dont see a lot of united) but guess what? None of them have been paid for...

thanks for bringing this up. I am going to look into this more.

 

[clubdeac]

Come to the VA. They pay for everything . . . so far 😀

 

[Doctodd]

what about using diagnosis code for Cervical radic for C2-3

 

[Mister Mxyzptlk]

If you want to do ONBs then bill them as trigger points injections. Bill them for spasm of the splenius digitalis longus muscles and see if anyone notices.

 

[Tenesma]

i did a C2/C3 (TON) RF for occipital headaches with great results (ie: >6 months relief)...

got denied.... if i had documented that it was for upper neck pain - then i could have slid through...

 

[Doctodd]

i did a C2/C3 (TON) RF for occipital headaches with great results (ie: >6 months relief)...

got denied.... if i had documented that it was for upper neck pain - then i could have slid through...

bingo

 

[Mister Mxyzptlk]

Sad that doctors have to lie in order to get patients treated.

 

[Jcm800]

Sad that doctors have to lie in order to get patients treated.

had the most real case of occipital neuralgia today. united healthcare. just called it a trigger point. uggh.