Injections and insurance

bryan868bbryan868 Posts: 21
edited 01/22/2017 - 1:53 PM in Spinal Injections
I had one treatment on 12/23 that included two transforaminal epidural steroid injections at S1 and L5 for S1 nerve root pinch from herniated disc. Unfortunately all my pain was back by day 2 and I'm still in pain 4 weeks later.

My pain management doc said because I did not get any relief from one treatment, my insurance will not cover any more. Apparently my insurance requires 50% improvement - which seems silly and arbitrary.

My doctor said I could pay out of pocket for another treatment, but he felt it probably wouldn't do anything anyway and recommended I see a surgeon.

 Maybe that's true, but I just didn't like how this whole discussion was framed with the insurance issue. Anyone else experience this?


  • jimandjrjimandjr Dallas TXPosts: 688
    When a nerve is pinched, for me, and ESI did nothing, the next step was surgery for me. This happened 3 times for me. 
  • scinmyheartsscinmyheart Posts: 110
    edited 07/30/2019 - 8:10 AM
    Bryan, are you saying that you have received just one set of epidural and because you did not receive at least a 50% improvement ,then your insurance will not pay for a second one? may want to contact your insurance company to verify that

    I do know with my insurance that I have to have a certain % improvement from an epidural before they'll allow a nerve block...then if the nerve block is good then on to a rhizotomy...but never not being allowed to get a second ESI just because the first one didn't help much...sometimes it takes more than one to help...other times after three they don't help much...but to cut it off after one I don't see

    ...I've never run into a problem getting 3 epidural in a year's time...then could do another set the next year

    good luck...hope you get it sorted out
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  • When I had an epidural in my neck, because i didn't have any real improvement, my insurance wouldn't cover more. I don't know what percentage was needed. My neurosurgeon sent me for nerve root block injections as a diagnostic test after that, so they covered those.

    With my lumbar issues, I had a facet joint injection. It gave maybe 50% relief for about a day. Insurance wouldn't cover another because for that injection to be repeated it had tho be about 80% better. For lumbar tranforaminal epidural, there didn't seem to be a pre-set percentage, and I had two, both of which only helped for about a day.

    My insurance is an HMO. I'm wondering if the type of insurance you have might make a difference. 
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