Insurance... I'm baffled!

[tripnstumble]

This is more of gripe then anything I guess.

Ok, so I was calling around about getting my MRI today when my Dr. called to see if I got an apt. yet. LOL She's more in a rush then I am. Anyhow, I asked her why just the brain? Why not do the neck and back as well since I do have a lot of back pain and my Chiropractor did want to rule out any disk issues. She told me with my ins. we can only do one body part at a time. NOW, I know as of late I am not the brightest light bulb in the pack but do you not think it would be cheaper to do it all at one time instead of three separate times. Or is their concept of thinking that if they find it on the first shot there is no need for the other two? This is just stupid... Also, I don't wanna do it 3 darn times in a row!!! I do not like that stupid machine and I do not like that stupid contrast lol AGHHHH

[HVAC]

Most insurances only allow one procedure or test at a time so MRIs have to be separated out. Also a Brain MRI is much cheaper than the other MRIs of neck or spine. The MRI is the most used test these days. There are more MRIs done in than basic blood tests. A brain MRI costs between $2000 - $3000 now. Spinal MRI $5000-$8000 more. All insurance claims go to one central place in New Jersey where the insurance industry studies the trends. I have learned all this from these Government health care meeting I go to.

Everything a Doctor does is ruled by the Insurance Company and there coding. In real time I can go on the computer and see every test I have had and every prescription I have gotten filled. I wondered how my Neurologist knew recent changes in Medication before I told him. It is pretty spooky. My GP does not dare fill prescriptions before 30 days. She has told me I can not come in any time I have a problem. I have to spread the visits out. I also can only have one condition treated at a time. I see a Neurologist once a year and can bring up one main issue. The hard part is choosing.

Alex

[Lulu54]

It would be great if we could really figure out the thinking of the insurance companies.  I know I usually get the forms for the preauthorization a couple weeks AFTER I have had the MRI done.

If your symptoms point more toward lesions in the brain rather than the spine it makes sense to do that first.  It also allows the doctor to look for other brain centered disease processes that could cause your problems.

If there is a need to look at your spine, they will do those all at the same time as a series.

Yes, insurance is frustrating but I am always grateful I have it!
Lulu

[tripnstumble]

My chiropractor wanted the back/neck MRI because of my headaches/migraines. I had an MRI about 5yrs ago due to the headaches/migraines which showed nothing. My PCP just wants the brain MRI. She says my insurance won't cover doing all 3 so she's not even asking. She also said "eeks" if I don't get my appointment for my MRI by next week she is making it for me LOL I guess I better get on the ball :) Just been so darn tired... Ugh. But, I'm just thinking cost of doing 3 separate is all.

Deb61, Fatigue is one issue I have that I just can not deal with. it drives me crazy! I'm so tired of being tired. I feel like I am just sleeping my life away. If your Doctor "insists" this is the only medication that works for you, your insurance still won't cover it?

Like I said, I had a brain MRI done about 5yrs ago and they couldn't find anything. I assume if there was anything at that time my Neuro would have seen it even if not looking for MS.

I have never seen this Doctor before and so far I like her. I gave her no indication of MS when I went in. I didn't tell her anything my other Doctors mentioned other then results of blood tests etc. Like I told my husband, this was her conclusion (MS) not mine. She does have on my papers cognitive disorder/Multiple Sclerosis. NO doubt I have cognitive issues. How my husband deals with that part is beyond me :)

Well, if they wanna do 3 at 3 different times so be it I guess :)

[Deb61]

I hate how the insurance companies dictate what the doctor orders.  It can and does happen this way and I see it personally not only through testing but getting the medication that works best for my fatigue.  I've been on Provigil for three years and has made a huge difference in regards to fatigue.  Now, the insurance company decides that they won't cover it.  I haven't found anything that works as well as the Provigil.  

In regards to the MRI, I usually just get the brain MRI myself.  The first real MRI (1st MRI on open machine doesn't count) I had it of the the brain and c-spine.  Lesions were discovered in my brain MRI which lead to my diagnosis. The other times after (except the ones completed a few weeks ago) I had only the brain MRI.   I've never had a t-spine MRI.  I wonder if this is because of what my insurance company will/will not cover.  

I like that your doctor shoots straight from the hip, is allowing you to shop around for the MRI, and at least considered your request for the c-spine and t-spine MRI.  It sounds like she didn't rule out getting these MRIs in the future if nothing shows up in your brain.

[johnniebear]

Each insurance co is different,  prior approval from my insurance co takes about three days and they use a third party I guess to make sure its  really necessary.

I would think it's really the way the Dr writes the order for the scan,  So is it a Chiropractor that ordered the scan?  if so you may have trouble having the brain , C-spine & T-spine  all done at once.

Johnniebear