Heavy wheels of the insurance machine are finally moving LOL

[lovemy6monkeys]

Holy cow this is taking way longer then I thought it would! Back in January I had a brain MRI, ordered by my PCP. He had also ordered c-spine and upper spine MRI's but insurance denied both of those. In early February I saw the first neurologist, who ordered a c-spine MRI. Insurance approved it, but before they approved it I "fired" that neuro and saw my current doctor (a neuro-opthamologist) for the first time. He ordered more tests, lots of blood tests, along with MRI's of the brain, neck and full spine.  

My insurance immediately approved the neck & spine MRI's. They denied the brain one since it had just been done a few months ago. My new doctor does not trust the lab that did that MRI. He said the machine is only a 1.5T and the lab does not follow MS protocol very closely. The lab he prefers to use does follow protocol closely and they have a 3T machine.

Anyway, my doctor appealed the denial. Insurance then approved a "down-graded" MRI, one not using contrast. Insurance called me with the decision yesterday so I called my doctor to see if that was ok or if he was going to appeal again. It turns out that this sort of thing happens often, so the lab will do the MRI as ordered and then bill insurance separately for the contrast. Now the thing that is holding it up is the c-spine test that the first neuro ordered and was approved. Insurance wont let them use the same authorization number and just switch the doctors name on the order. So, yesterday the neuro had to fax them a cancellation of that order, then today my new doctor faxes them their order, and, if I'm very lucky they should approve the order today or tomorrow.

I'm hoping that means I can get the MRI's done in the next week or so. Basically, my doctor said to plan on it being a full day appointment. I will have the MRI's done first, then go right to his office and they will try to "squeeze me in" and he goes over the images right there with us along with the blood test results.

*please, please, please let this all workout soon! LOL*
~Jess  

[mary2010]

Its really sad that insurance companies have so much say regarding a patients care and treatments, in essence hmos are practicing medicine without a medical license which is unethical and from what I understand illegal.

I have had repeated problems waiting for hmo authorizations for very necessary procedures or tests, which have delayed my recovery and treatment in the past because the HMO was fighting the doctors decisions about what is best for me. It all comes down to money and the insurance companies do whatever they can to save a dime regardless of the patients best interests. Insurance companies are the gate keeper so to speak.

I hope you are able to resolve the issues soon, it sounds like your doctor is better than most. There are some good doctors out there but in my experience in the past ten years of having MS, I learned that they are difficult to find, its easy to find an HMO stooge but a doctor that will go to bat and order expensive tests for you is a rarity.

Mary

[Ginosmommy]

That all sounds like a pain in the butt, I wish you all the luck that the insurance approves everything. Your new doctor sounds like a keeper!