Getting past insurance roadblocks

[jumpinjiminy]

Here's the latest challenge in the race for a diagnosis and treatment before some major function is lost forever. I was told by the MS doc that there might be something in my spinal cord, but imaging should be done there to find out for sure. Now I can't find a doc that will order that imaging, because they can't find a clinical reason to order the testing. If I had a different insurance company, it would be allowed. But mine requires a months worth of treatment and documentation before that type of testing can be considered. That's why it's all taking so long!

And, because my blood labs are all coming up negative, they can't do any further lab work to check for lupus antibodies. Because the SCREENING tests aren't showing anything. Why? Because the insurance requires it.

I would really like for the insurance to get out of the way, and let the doctors do their jobs. I don't pay them premiums so they can stall and thwart diagnosis and treatment of my health problems.

Grr!

[jumpinjiminy]

I hear you on the private facility thing. It is the one the neuro recommended. A couple of years ago, I called around for pricing on imaging for the lumbar spine. The private facility wanted $250. The hospital wanted $2500. For the same test. And the imaging facility's magnet is a 3T. The hospitals is a 1.5T. Huge difference in price. There must be the cost difference because a hospital is a) managed by a company traded on Wall Street responsible for profits for investors and b) hospitals are forced to find ways to cover costs for the uninsured and bankrupt needing care they have to serve. Those are the only reasons I can figure for their hugely inflated prices.

I would much prefer to use the private imaging center. Although, the insurance will only pay so much for the test. So it's likely the hospital doesn't get that full amount anyway even if they do bill for it.

[jumpinjiminy]

The MS doc says I don't have MS, and so is not taking me on as a patient. Therefore, he will not order an MRI. I asked him for the names of docs he thought would be good to handle this if mine runs into dead ends. He gave me the names of the resident and attending neurologists I saw in their ER the night after the flashing lights episode. He said they would be interested in following up on this. He said he could pick and choose this person that specializes in this, and that person that specializes in that. I don't know if he knows these two docs, or if he just saw I had been evaluated by this resident in the ER and thought she would want to follow up from the previous contact. I'm an interesting study, apparently. lol

As far as the insurance, yes, we are stuck with it. The only other two options during open enrollment are HMOs. One doesn't pay out of network at all. The other, is the same insurance company we have now, just a different plan and more restrictive on who you see as well. The insurance pickings grow slimmer and less attractive every year. They take more and more away, and charge more. It's getting ugly.

It's okay. It's just slowing things down needlessly. If things go south quickly, it's them that will be paying the higher bills as a result. Unfortunately, that would make me less able to earn myself. All around a bad thing. There is the chance that won't happen too. So I'll hang my hat on that possibility for the time being. No need to add more problems on top of what are already brewing.

[HVAC]

Most insurance companies are cracking down on MRIs period. All insurance information without personal data goes to one big clearing house, where the industry studies it. They have found MRIs are the most used test or procedure in the country. At over $3000 a MRI the industry is trying to make sure they are necessary. Most insurance companies will now only pay a third. I have this information from sitting in on health care governmental meetings.

One thing that helps with cost here is to get the Doctor to send you to a private imaging place and not the hospital, they charge less and the insurance may accept it more easily. For me it is half the cost for the same MRI at the hospital.

Hang in there.

Alex

[essdipity]

I can understand why you're angry and frustrated. Anyone would be---it's like a catch-22.

Are you stuck with this insurance? Is there an open enrollment period so you can change providers?

One other question. Why can't the MS doc order the imaging? That does seem like the logical person.

Hang in there,

ess