My insurance denied paying for a cortisone shot for a torn meniscus

[question everything]

I received a denial letter today, for an office visit from March! The insurance paid, as I did my copay.

The reason: "isn't covered by either Medicare or my plan." So I went to the "exclusion" section which is from 2021 and the first item is: Services considered not reasonable and necessary according to the standard of Original Medicare.

So I went to the Medicare site and they do approve Arthroscopy surgery to repair a torn meniscus but my orthopedist decided to start with a cortisone shot and it helped. So why not approve a cheaper treatment?

Yes, it was an expensive office visit: new patient, X-ray: I am not bone on bone on the knees.. and, of course, the shot.

I am pissed. And, of course, with the blizzard outside and two days before Christmas and then the last week when many take off, not much chance of talking to anyone.

Oh yes, I can appeal, but my first reaction was: had this letter arrived two weeks earlier, I would have looked at other carriers.



P.S. I see that there is Medicare Advantage Open Enrollment from Jan. 1 to March 31. I may look at it. As far as I know mine is Medical Advantage.