United Healthcare

[Multimodal]

So my billers just informed me that the United Healthcare (if you can call it that), in our area(PNW) recently changed their LCD for cervical ESI. To my surprise, cervical freakking radiculopathy is no longer medical necessary.....however thoracic and lumbar radiculopathy are considered necessary for ESI in those areas. What the everloving F*$& is going on with these insurance companies?! had to rant about this

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[Sig123]

So my billers just informed me that the United Healthcare (if you can call it that), in our area(PNW) recently changed their LCD for cervical ESI. To my surprise, cervical freakking radiculopathy is no longer medical necessary.....however thoracic and lumbar radiculopathy are considered necessary for ESI in those areas. What the everloving F*$& is going on with these insurance companies?! had to rant about this


View attachment 340748

So stupid if true -- just pay their stupid games back. Everyone will now be thoracic radiculopathy and still get a C7-T1 ILESI

 

[Multimodal]

https://www.uhcprovider.com/content...g/epidural-steroid-injections-spinal-pain.pdf <- here is the link to the updated LCD from their website. It took effect in May 2021. I sure hope your LCD is different

 

[Orin]

Wait, ESIs are covered for diabetic neuropathy?

 

[deleted875186]

3 epidurals per year? Where do they get these numbers.

 

[deleted875186]

Just need a few more plans to stop covering injections and a lot more people will get behind Medicare for all.

 

[Nodolor]

3 epidurals per year? Where do they get these numbers.

I agree with 3 ESI in 12 months in each area ...if needing more it is probably not a good treatment

 

[Agast]

I agree with 3 ESI in 12 months in each area ...if needing more it is probably not a good treatment

Q3 months for a poor surgical candidate is not unreasonable. Why make them wait another month.

 

[DODOCSS]

euflexxa for all commercial w/ fluoro in facility, let them eat the cost of sos

 

[gdub25]

We have had the same policy change here regarding CESI. Not getting paid for cervical radiculopathy

 

[bedrock]

We have had the same policy change here regarding CESI. Not getting paid for cervical radiculopathy

Wow. I will have to check my local LCD

 

[RoloTomassi]

We have had the same policy change here regarding CESI. Not getting paid for cervical radiculopathy

Wow. Where are you?

 

[Agast]

We have had the same policy change here regarding CESI. Not getting paid for cervical radiculopathy

Which ICD 10 code did you switch to?

 

[gdub25]

I’m in Oklahoma.

We just picked a covered diagnosis off their list. See attached.

 

[deleted875186]

I’m in Oklahoma.

We just picked a covered diagnosis off their list. See attached.

Intervertebral disc stenosis of neural canal of upper extremity …..

And they won’t accept cervical radiculopathy. What a joke.

 

[nvrsumr]

Cat and mouse. Will take years for some practices to realize they aren’t getting paid. Thank u sdn