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402504 tn?1241996524

Insurance won't cover spinal or thoracic MRI

I recieved paper work from my insurance company today about requested procedures.  The title that reflects the doc's reason for needing procedures was "Suspected Multiple Sclerosis".  Then came the list of denials.  The head MRI was approved, but the MRA was denied because it didn't fit the diagnosis (what?).  Thoracic and spinal MRI's are denied until a head MRI is suggestive of MS but not firmly diagnostic.  Well I have already had my head MRI and it didn't show any lesions, at least not that the radiologists saw, but he only used the stroke protocal not the MS protocal when reviewing my MRI.  I thought MS could show up with lesions in any of the three areas, not necessarily the brain first.  Am I wrong?  Is this normal for insurance companies or just mine?
6 Responses
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378497 tn?1232143585
Fight the denial. Call or write after you've marshalled your medical explanations--and enlist your doctor's assistance--and fight the denial. There is not a good medical basis for not approving this scan.
Helpful - 0
147426 tn?1317265632
The clerks in the insurance office don't know diddly squat sometimes.  I had my thoracic MRI denied until I got a diagnosis of Myelopathy (disease of the spinal cord) on the reuquisition.  Then it was approved automatically.  MS should have done it.  They are making you run through the hoops.  I am so sorry.  Take Biowham's advice.  Put the whole thing together and file an appeal.

Their criteria for denying the spinal are faulty.  If the decision is being made by a nurse or a clerk, you (an preferably an insurance attorney) can accuse them of "practicing medicine without a license.

MS can occur with spinal lesions only.  I am almost an example.  I have one small brain lesion, located atypically, and 6 spinal lesions.

What they are doing is criminal and someone needs to say this to them.

Quix
Helpful - 0
402504 tn?1241996524
Thank you for your response.  It is very easy to get discouraged at this point, but I will fight this. Thanks, and also I pray that God will bless you for all that you do on this forum.
Helpful - 0
382218 tn?1341181487
Check out the following journal abstracts that are posted on the following site:
www [.] ncbi [.] nlm [.] nih [.] gov

The URL's for each article are too long to post here, but just search the titles on the above site, or try googling the titles as this should direct you to each specific journal in which they were originally published.

Findings such as these may add weight to your appeal.



"Spinal-cord MRI in multiple sclerosis."
Note where it says, "In the diagnostic setting, spinal-cord imaging is valuable."


"Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI
examination."
Key finding of this study: "Spinal cord abnormalities are prevalent in patients with early-stage MS, have distinct morphologic characteristics, and help to determine dissemination in space at time of diagnosis."

"Spinal cord magnetic resonance imaging in suspected multiple sclerosis"
Key finding of this study: "Spinal cord abnormalities are common in suspected MS, and may occur asymptomatic. Although diagnostic classification is seldom changed, spinal cord imaging increases diagnostic sensitivity of MRI in patients with suspected MS. In addition, patients with primary progressive MS may possibly be earlier diagnosed."


Good luck with your appeal.

db




Helpful - 0
382218 tn?1341181487
bumping up for msturbo
Helpful - 0
428506 tn?1296557399
Hi,
I did have similar issues.  First I was send to get a brain MRI with and without contrast, but when I got to the radiology center, I found out my insurance would only cover the MRI w.o. contrast.

After the MRI, the neuro told me by phone the MRI was clear.  But at my next appointment with him, he did an EMG test that was normal.  Then he told me that there were some "spots" on my brain MRI without contrast, and that he would again order the brain MRI with contrast, and also c-spine with and without.

The insurance DID approve the 2nd set of MRI's, but only when he "decided" that the 1st MRI was inconclusive.  To make things MORE confusing, that decision seemed to change after my EMG.  

In the end, my extra MRI's didn't answer anything, since the "spots" on my 1st MRI did not light up with the contrast, and the c-spine was normal.  But I digress...

So, in summary and in answer to your Q, Yes!  My insurance also wasted a lot of time by not approving all of the neurologist-ordered MRI's in the first place!

~W
Helpful - 0
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