Urgent questions... Very frustrated!

I finally went to see another doctor who ordered the MRIs that Dr. Batzdorf (and all the other doctors for that matter) want to see before determining our eligibility as patients.  I had my brain MRI done last week.  A third party company my insurance company uses to determine whether or not these things are "medically necessary" (N.I.A.) had pended the other two MRIs.  Now I get a letter from them denying them.  AUGH!!!!  I am so sick of insurance companies, who do not see us as patients, choosing whether or not we get care!

I don't know what to do.  I called and informed Dr. B's office that they pended these and was told then that he needed all of them to make an evaluation.  I have MRIs from last year, and I am going to go ahead and try to see if he will accept them in lieu of new ones... but they knew that before they requested new ones.

I have a question that I would like to have each of you respond to - if your answer to my question warrants it.  How many of you have CM1 that is/was 5-6mm?  For those who are 5-6mm:  What were your symptoms?  What was done?  How long did you go between the findings and any sort of real treatment for the Chiari?  (Please also feel free to add anything else you feel is pertinent.)

I listed this as "urgent", as I have 30 days to file an appeal with the insurance company.  I would like to send along your emails, if you don't mind, so that I have other information than my own to back me up.  (Therefore, I would request that you email me directly as opposed to doing a web post... unless the administrators believe this is something that would be beneficial for others.)  I am also considering getting the insurance commission involved... but I may use that as my last resort.

I am losing my mind with all of this!  I am so depressed and so intensely frustrated that I am about to shut down on it.  If I do this though, I will end up losing my disability too, because there will be no one to fill out their stupid forms and claim to have a clue as to what I'm going through.  (Which may be a nervous breakdown soon if I don't quit getting treated like I'm crazy!!!  Ok, so I know I sound that way right now, but seriously, you all know where I'm at.  Why is this so hard?!)

I suspect that my insurance company is probably thinking, "We only have to insure her through April 2010.  If we drag this out long enough, we don't have to pay anymore of her claims."  And, of course, the holidays are fast approaching, so that is going to take a big bite out of the time I have.

It is bad enough that we have to take our health care into our own hands.  We certainly aren't the ones getting paid to provide it.  Where are the doctors that truly care?  (I am blessed that my new/old pcp does care.  They have now just tied his hands.)

Thank you all for "listening" to me vent... I can't tell you how much it means to have a "family" of people who know and understand exactly what we are dealing with.  And we AREN'T crazy - just mad!

Blessings to you all!

[n40066]

is it possible that your dr. can use a different code when requesting these tests?  alot of the time, that is all that is needed!  good luck!

[selmaS]

Hi Hang in there will send u some info via a PM.......and u r right many of us do get down right mad at the way we have to handle this for ourselves or not get the proper treatment.

"selma"

[chadry]

I had the same thing happen when a new set of MRI'S were ordered for my DD. They approved the brain and cervical but not the thoracic. They said there was not enough evidence to check for a syrinx at this time.
I was told that if the doctor's office would take back the order and reorder it and add more info there was a chance it would be approved. i did not have enough time though because of the scheduling to get this done.
Good luck. Maybe you should really think about appealing it.
Chadry

[sheila53213]

I was dx this past Oct with CM1 6mm...then it went to 8mm....now it is back to 6mm. I am currently trying to find a surgeon to take me seriously. My NL takes me seriously and acknowledges my symptoms and the crowding I have.
At first, I was being treated for migraines because they were so bad and I was having the aura with them. However it did not stop there. I am currently experiencing a laundry list of symptoms. You can PM me if you want a full list.
I am currently on a mess of pills that are not working.....they are alleviating the intensity of my symptoms but they are not making them go away at all. I was being treated for migraines for almost 6 years and just now a knowledgeable person made the dx of Chiari. So I am still trying to get "modified" as I call it because I know I will never be fixed or cured. Just "modified" to try to lead a normal life with my boys.
If you have any other questions just let me know.
I hope this helps you a little bit!
Sheila