Case Number: 202204-148550 Department of Financial Services
The plan states that his severe pain is not responding to medications like non-steroidal anti-inflammatory drugs (NSAIDs), Toradol and oral steroids. He is unable to tolerate physical therapy. They would schedule him for a right L4 and L5 injection to facilitate pain control and physical therapy. He would be referred to a spine surgeon if the
Actived: 3 days ago
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(Just Now) If the injections fail, he will be referred to a surgeon. The request meets NIA guidelines and standard of care. The health plan did not act reasonably, with sound medical judgment, or in the best interest of the patient. The insurer's denial of coverage for pain injections (64483 X1) (64484 X 1) is overturned. Medical necessity is substantiated.
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