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  • Denied MRI

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    Old 01-18-2019, 07:08 PM   #16
    yayagirl
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    Re: Denied MRI

    Dear jrwest100,

    I am not positive about all states, but I think in America that all insurance has to honor a request to get examined outside of your medical group. Doctors in a medical group do stand by each other, which they should. But that is when we need medical opinion outside the group.

    What kind of insurance do you have?
    My daughter's insurance gave her the same kind of runaround while she suffered and she could not get proper treatment until she dealt with her insurance company as I mentioned above. Then the new doctor ordered the MRI, she got it, and the new doctor helped her recover.
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    Old 01-19-2019, 09:08 AM   #17
    jrwest100
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    Re: Denied MRI

    Thank you for all the replies.
    I am going to follow up with pcp sometime next week and see what she has to say,if maybe she wants to overstep the pain people and send me to a spine ortho.
    Unfortunately myni surance is very limited, its a ppo, so i have to see who is on the list.i can go to the neighboring hospital system, but then i pay full price out of pocket
    Thank you

     
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    Old 01-19-2019, 11:42 AM   #18
    yayagirl
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    Smile Re: Denied MRI

    Dear jrwest100,

    Some states require that insurance pays for second opinion outside the medical group.
    You can call your county or state representative to ask where to find out how to get that information.
    Also check with your insurance company.

    Some PPO insurance voluntarily pays for medical opinion outside the medical group, as it keeps costs down.
    You can also consult an insurance sales person to find out this information. These are often little known insurance benefits. I didn't know
    until a friend told me.

    Let us know what you find out.
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    Old 01-20-2019, 04:48 PM   #19
    teteri66
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    Re: Denied MRI

    Has anyone suggested sending you 59 PT? That often goes hand in glove with the epidural steroid injections. You are really at the mercy of the PT you are sent to as unfortunately only a small percentage of them have sufficient knowledge and experience with orthopedic spine issues to be of much use. But in the right hands, it can be of great benefit!

    The trend is to not offer MRI as the first line of “treatment” as was always done up until recently. Too many people were being rushed into surgery when a bulging disc was seen on MRI. But, when there is obvious nerve compression (as indicated by numbness, etc.) you cannot leave the nerve compressed indefinitely!

    Have you tried using ice and heat as a treatment on a regular schedule? Ice can be as effective as oral medications...sometimes, anyway!
    (That is to say, oral medications don’t work very well for nerve pain...but that’s another story....)

     
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    Old 01-30-2019, 09:26 PM   #20
    jrwest100
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    Re: Denied MRI

    Some update
    So saw pm pa, and will re-appeal the mri.should hear within the week.
    Have been doing aqua therapy.hard to say what i think of that.leg still numb/burning.actually the exercises KILL be my si joint.i actually went to pick up mu gym bag,felt something catch,snap,let-go on that rt side,and here came the severe spasms on the butt/hip. Pounded the muscle relaxers, took it real easy,and it settled down in 3days.went again yesterday,and my rt butt hurt again afterward.
    Definitely think 2 different things going on here.
    Pain PA also discussed neuro surgeons.
    So its a step in a direction,anyway

     
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    Old 01-31-2019, 08:17 PM   #21
    teteri66
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    Re: Denied MRI

    If I were in your shoes, I would put off further aqua therapy until you get the MRI and they figure out what is going on.

    With the apparent nerve compression, you could be doing more harm than good. You might want to try alternating ice and heat for the pain.

     
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    Old 02-08-2019, 03:49 PM   #22
    jrwest100
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    Re: Denied MRI

    Well,some interesting things.
    Mri denied again.their excuse is i havent done 6weeks of conservative treatment. Pain spec. Appealed for 3rd time.
    Also found out if i want to see an outside doc,it will be a 150 dollar copay.i have already bern nickel and dimed(pcp 30 bucks,pm 50 bucks,ed visit 195$,urgent care 72$, epidural steroid facility fee 250 bucks.And i have not gotten ant paychecks for disability rrom work d/t pcp farming out the transfer of records/notes to a 3rd party.
    Im going to give up and limp back to work,as pcp wrote rtw date the 11th.
    I wonder if id be better off paying out of pocket. Pay for spine doc, and pay for mri.naybe id get an actual answer amd treatment then😒

     
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    Old 02-08-2019, 04:14 PM   #23
    yayagirl
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    Re: Denied MRI

    Dear jr,

    Where are you located? Are you in the US?
    what is your insurance company?
    What entity is calling the shots?

    If you go back to work prematurely will that interfere with healing or getting Disability pmts?
    Do you have any family that can help you while you recover?

    Pcp wrote rtw date to be the 11th??
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    Old 02-08-2019, 09:26 PM   #24
    teteri66
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    Re: Denied MRI

    Has there been any change in your symptoms? Who specifically is directing your care?

     
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    Old 02-09-2019, 01:41 AM   #25
    jrwest100
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    Re: Denied MRI

    Hi,I'm in the US.all i can guess is that the ins.co. has changed,or it could be the employer,and thats why this keeps getting denied.
    As far as directing this,i guess the PM states they are.they say no referral to spine doc until mri is done.i want to call ins,but I dont want to step on their(pm) toes. They said they will appeal a 3rd time
    Thing is, they dont do time off, or work excuses.So that puts it back in the pcps hands.
    This is so upsetting.I cant say anything to the pm people,as im afraid they would let me go,and the only other option is a doc who has terrible reviews.otherwise, I think I'd be more insistant.
    Thanks for listening

     
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    Old 02-09-2019, 08:23 AM   #26
    teteri66
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    Re: Denied MRI

    Again, any change in symptoms? Are you still in PT?

     
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    Old 02-09-2019, 09:15 AM   #27
    yayagirl
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    Unhappy Re: Denied MRI

    Dear jrwest,

    PM is working for the insurance company. So now you know, if you are in too much pain to work and it would further injure you, you cannot make them give you pain meds, but it is entirely up to you to say 'I cannot do the job in this pain'. Don't be intimidated at all. Just be honest. They know the rules. You have to know them, too and protect your side of this. They are not there to protect you from yourself. This was something I had to learn, and I think we each have to learn to stand up for what is true for ourselves. Keep a record of what you say to who and when it was was said. All of this supports your case. Get a small notebook and keep notes and dates and names in it. Record all of what you already know and experienced and then keep adding to it. This is our own responsibility.

    I saw that a workman's comp resource was added at the top of this to the board. I was already thinking maybe it's time to talk to an attorney before you permanently injure yourself. You know, I had to get an attorney against a store that had left a big puddle of water from a leaky refrigerator near the check out which I slipped in, and my feet flew up so fast I fell flat on my back in front of the checkout person and several customers. I had automatically put my hand down to try to catch myself from the fall that my wrist was broken and I cannot get on my bad knees, so I could not get off the floor. It seemed like it took forever for the ambulance to get there, and they kept checking people out that walked around me while I lay there flat on the floor in water.

    Let me tell you that workman's comp can act as if they are there for the employer, which they are of course, but it is also there for your protection. And, it is the squeaky wheel that gets the attention. We do need to follow doctor instructions, but also if you go back to work prematurely you can have permanent consequences. Absolutely do not go back to work before it is safe to do so. And, it is entirely is up to you to know when it is safe. If you can not function safely and without pain, you have to state that and tell them to write it down. If they are not looking after your best interest, you alone are responsible for speaking up.

    I am not a person that spoke up about anything when I was young. But I did learn it is not only my right, it is my responsibility. We don't need to jump the gun, but in your case it seems like time to ask your boss for the name and contact information of the insurance company so you can turn it in to an attorney. Do not say that unless you do plan to take action. You don't even need the attorney's name yet. We can just state we are getting one. And, find the best work injury attorney you can and I suggest that you talk to a big well known company as they have the money power to stand behind you; it's free to talk to an attorney and find out what you can do. A good attorney will make sure that you are given the very best possible care for your recovery and not forced back to work prematurely.

    The whole idea here is that you are protected, and that you get the quickest and very best possible recovery in order to get back to work. But no one is going to look out for our best interest except our selves. It's up to us to set limits on what we can do and to not re-injure or continue to re-injure ourselves. So, you alone have to decide if it is safe for you to go back to work.

    You are not required to work with debilitating pain.
    Just be straightforward and honest about what you can and cannot do.

    Hugs,
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    Old 02-09-2019, 08:57 PM   #28
    jrwest100
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    Re: Denied MRI

    [QUOTE=teteri66;5492201]Again, any change in symptoms? Are you still in PT?[/QUOTE]
    Hi,I stopped the Pt,as now i cant afford the copays.When I did do it,I felt discomfort,but it was in a good way.I still have weakness and paresthesia on the leg,but gabapentin is helpful.its just that gabapentin makes me queasy.
    I realize I have lost a lot of muscle.I hope I can regain it.Going to try more PT when I get money.

     
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    Old 02-09-2019, 09:07 PM   #29
    jrwest100
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    Re: Denied MRI

    Hi yayagirl,
    Thank u so much for the information.Unfortunately,this isnt workmans comp.But certainly the documentation can be noted.I am going to give the PM people one more chance.i am going to ask them if they could refer me to the spine doc. I dont see why we cant discuss the problem even without mri.i have old ct scans and a really old mri documenting ddd and spondylosis.
    I will return to work and be very careful.if i become in unbearable pain,i will have to call out and see pcp. wish me luck, and thank you all for your suggestions !

    Last edited by jrwest100; 02-09-2019 at 09:09 PM. Reason: Cant spell or type

     
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    Old 02-10-2019, 05:45 AM   #30
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    Re: Denied MRI

    jrwest,
    I went through this thread trying to find the answer to this question, but didn't see it. Do you need a referral to a specialist?

    You do not want to play games any longer with the Primary Care doctor. Go see an Orthopedic doctor, get the correct tests and let them refer you to either another Physical therapist or Pain specialist..or Spinal specialist.

    If you do need a referral- go see your doctor and tell them you are done playing games and wish to be referred to an Orthopedic or Spinal doctor.

    Skip the rest of it and advocate for yourself. If you still have issues, call the insurance company and find out how to appeal your primary care's decision. From what I can see this has been going on for near 2 months and you are still having pain and no answers...time to press forward.

    Good luck!~
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