Tired of Knee Pain? How To Get a New Osteoarthritis Treatment Covered by Insurance
The non-invasive procedure takes just one to two hours and most patients go home the same day
Key Takeaways
- GAE may ease knee osteoarthritis pain when other treatments haven't helped.
- Careful medical documentation may improve your chances of insurance coverage.
- The procedure doesn't cure osteoarthritis or eliminate the long-term need for knee replacement.
You never turn down an opportunity to play hide-and-seek with your granddaughter, and when a friend calls in absolute need of your signature dessert, you head straight to the kitchen, standing on your feet for hours. You’re still doing all the things that make you you, even while navigating knee osteoarthritis pain. But what if we told you there’s a one- to two-hour outpatient procedure that could curb your pain for a year or more—and it may even be covered by your insurance? No, it’s not science fiction. We asked experts to break down everything you need to know about this groundbreaking treatment known as genicular artery embolization (GAE), including who it’s for, how it works and the steps that could help you get it covered.
What is osteoarthritis?
“The most common type of arthritis is osteoarthritis, which occurs as a result of the loss of cartilage at the end of a bone,” explains Sadia Saeed, MD, physician and medical advisor with Welzo. “This results in an individual experiencing joint pain, reduced motion and stiffness and swelling. These symptoms occur as a result of joint deterioration.”
Dr. Saeed says major causes of osteoarthritis include:
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- Trauma or injury to the joints
- Genetic predisposition
- Obesity
- Strain or repeated stress on the joints
- Wear and tear on the joints from aging
Currently, common knee osteoarthritis treatments include:
- Exercise
- Physical therapy
- Over-the-counter medications to control inflammation and pain
- Weight loss, if needed
- Activity modifications to reduce discomfort
- Joint injections
- Knee replacement, if more conservative treatments haven’t worked
What is GAE, a new treatment for knee osteoarthritis?
If the above treatment options either haven’t delivered the relief you’d hoped for or aren’t right for you, GAE could be the key to helping ease the pain and stiffness that limits your daily activities.
“Genicular artery embolization is a non-invasive process that reduces the blood supply to the inflamed areas of the knee joint,” explains Dr. Saeed. “This is done with a very small catheter placed via an artery in either the wrist or the groin area and directed to the small arteries that feed these inflamed regions. After which, the embolic agent [small particles] is released into the arterial system to stop the excessive blood supply to the knee joint. GAE generally can be completed within one to two hours. It is common for patients to go home on the same day as the procedure, and recovery time will likely be in terms of days rather than weeks.”
Research on GAE’s effectiveness for knee arthritis
Sometimes a medical procedure sounds too good in theory to work in practice, but research shows GAE lives up to the hype.
In a new study in Radiology, 194 people with osteoarthritis-related knee pain had already tried at least three months of conservative treatments, including anti-inflammatory medications, physical therapy and steroid or hyaluronic acid injections, without enough relief. But after a single GAE procedure, their median pain scores dropped 57 percent over the next year.
Dr. Saeed says the findings suggest that people who find other knee osteoarthritis treatments to be ineffective could get clinically significant pain relief from this procedure.
Could GAE be right for you?
“GAE is a spectacular alternative for women looking to avoid major surgery or buy themselves valuable, pain-free years,” says Anita Gupta, DO, MPP, PharmD, FASA, board-certified anesthesiologist, pharmacist and expert in health policy and pain medicine. “However, candidacy depends heavily on the structural stage of the arthritis.”
Ideal GAE candidates: Adults experiencing moderate to severe chronic knee pain without relief after at least three months of physical therapy or injections, or who have localized tenderness along the knee joint line, are a good fit, says Dr. Gupta.
Poor GAE candidates: People with bone-on-bone, end-stage osteoarthritis (grade 4), where mechanical joint failure is the main driver of pain rather than inflammation, are likely not a good fit, she adds. It also may not be a good fit for those with a joint infection, kidney impairment that could make contrast use unsafe and osteoarthritis pain coming from another source (like the spine or hip).
Rab Nawaz, MD, a board-certified neurologist, reminds us that while GAE can be a helpful treatment for pain relief, it does not cure osteoarthritis, correct major joint deformity or regrow cartilage.
Is GAE for knee osteoarthritis covered by insurance?
So, you’re sold on giving GAE a try, but you’re not sold on what Advanced Medical Group says is a $4,000 to $10,000 price. Can you use insurance to take some of the financial load off? Potentially.
“There are many variations in insurance coverage for GAE due to the fact that most health care providers view it as a relatively new treatment option for osteoarthritis,” says Dr. Saeed. She adds that the following strategies may increase your chances of getting the procedure covered for knee osteoarthritis:
- Documenting continuous pain
- Using conservative methods to treat your osteoarthritis first (physical therapy or medication)
- Getting images that confirm you have osteoarthritis
- Providing clear clinical notes from your physician indicating why previous treatments didn’t provide enough relief
“If insurance denies coverage for GAE, your physician and/or you may be able to get the denial overturned through an appeal process by submitting additional information—(medical records, recommendations from specialists, etc.—proving that the GAE was medically necessary,” adds Dr. Saeed.
The bottom line on knee osteoarthritis treatment
Just as there’s no one-size-fits-all approach to health, there’s no universal approach to managing pain. Even if your friend swears a knee replacement changed her life or steroid injections have helped your cousin, it doesn’t mean either option will be right for you. The good news is that as medicine continues to evolve, there are more ways than ever to treat knee osteoarthritis pain. Talk to your doctor about whether GAE could be right for you. It could offer a middle ground between conservative treatments and major surgery, and with the right documentation and persistence, you may be able to get your insurance to cover it.
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