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  • Denied MRI

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    Old 02-10-2019, 06:49 AM   #31
    yayagirl
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    Re: Denied MRI

    Dear jrwest,

    Ok is what is going on from the long term health issue? Or is it from a new injury?

    In America we are not stuck in a medical group that keeps denying care. We are here to help you see avenues you can take, but you have to call the insurance company yourself to state what you want, and yes, pay your co-pays. Your health and functioning is at stake. Doctors and work personnel cannot and will not work for us unless we do our part.

    Either way, it is up to you to stop asking the same people you already saw that are not helping, because it also is up to you to call your insurance company yourself and say you need to be seen by an expert outside of your medical group.

    In America, by law they cannot deny you that. Yes, of course, pay what it costs to get that other opinion. Borrow the money if need be. At least then you know what you have to deal with. The insurance companies have knowledgeable nurses on call to help you make those decisions and give you the needed phone numbers. Recently I needed to go to a credit union and borrow money for a procedure that I needed that is not covered by my insurance. It happens to most of us.

    If this is an old injury that is just getting worse, at some point you may have to stop working. But you need other opinion outside that medical group to help you make this determination. Be sure you are doing all you can do for yourself, resting, getting proper exercise, eating right, etc, because no one can do those things for us.

    Blessings,
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    Old 02-10-2019, 09:54 AM   #32
    jrwest100
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    Re: Denied MRI

    Hi MSNik,
    Thank you for your response.It is the Pain mgmt people who are in"charge"of this at this point.i have been going to them for years.Have not been referred to ortho/spine doc because the shots/meds usually nade things tolerable .The discs,and spurs usually would settle down after ESIs,oral steroids(i cant do nsaids)PT.etc.
    This time was the most severe ever.it also didnt resolve like the others.Pain management is controlling this at this time.PCP did her own dx,and said continue to see Pain mgmt.Only thing pcp was doing was defining period of disability.Pain management states now that is not.their policy.
    I am fairly functional at this time ,but only for short periods of time.I still want to see an ortho-spine,as im afraid the paresthesia is permanent.one can only have so much patience
    Thanks for the encouragement and responses.

     
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    Old 02-10-2019, 10:07 AM   #33
    yayagirl
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    Re: Denied MRI

    Dear jrwest100

    Pain Management is not who to ask. They can only manage pain medication.

    If you dislike the current primary care doctor you have, you have to call your insurance company and tell them that you are in worse serious pain, have requested an MRI and to seen by a specialist and are being denied, and that you want an appt with a doctor that will take care of you.

    You have to tell [u]your insurance company[/u] that you are in much worse pain, do not want different pain meds, have requested an MRI and have been denied and that you want a second opinion by a doctor that will take care of your health problems.

    Doctors are just people, and people have their own agendas and personalities. Other people don't always listen to us or understand where we come from. When they are not open to what we need and who we are, we need to move on and contact someone above them. It is the same for all of us, hon.
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    Old 02-10-2019, 10:19 AM   #34
    jrwest100
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    Re: Denied MRI

    Hello,its the Insurance that is denying the MRI.Pcp said continue to see Pain mgmt.i complained to pain management a few weeks ago,saying the ESI didnt work this time ,and why mri rejection x2 by my i surance,or ortho referral ?pain mgmt told me i was being anxious and to be patient ;they would appeal.

    Its the insurance that is dictating some of this.i never thought id be playing that game,esp when in 2013 i got an mri for disc herniation on the left right away.
    Now i know why so many drs and such are quitting or retiring-they cant get their pts to have procedures or tests as unsurance denies it. And who has that kind of money laying around.

     
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    Old 02-11-2019, 09:38 AM   #35
    yayagirl
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    Re: Denied MRI

    Dear jrwest,

    I know this is tough, especially when you are not well.
    It does help if you can get a friend or family member to help you with these matters.

    Below are some great resources. It takes time, but we just need to persevere.
    https://www.healthcare.gov/appeal-insurance-company-decision/appeals/
    https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/
    https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

    Love,
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    Old 02-11-2019, 10:15 PM   #36
    jrwest100
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    Re: Denied MRI

    [QUOTE=yayagirl;5492249]Dear jrwest,

    I know this is tough, especially when you are not well.
    It does help if you can get a friend or family member to help you with these matters.

    Below are some great resources. It takes time, but we just need to persevere.
    https://www.healthcare.gov/appeal-insurance-company-decision/appeals/
    https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/
    https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

    Love,[/QUOTE]
    Thank you yayagirl,that is very kind of you😊

     
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    Old 02-12-2019, 07:00 AM   #37
    teteri66
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    Re: Denied MRI

    Hopefully one of these links will contain information that will help you.

    It seems to me that, with the increase in the number of pain management specialists and clinics in recent years, we are going about things backwards when it comes to treatment. To me, it makes sense from both the medical and financial side, to obtain an accurate diagnosis first before deciding on a plan of treatment.

    I know too many people who were referred to pain management by their PCP who did not have an accurate diagnosis.... who were then treated for a long time, only to find the “problem” was not resolving or was getting worse. My recent favorite example is a friend of mine who had pain in arm and wrist...was sent to pain management where she underwent treatment for months. The PM decided finally she had carpal tunnel and would need surgery and finally referred her to a hand surgeon. Luckily that doctor had the sense to order some testing where it was discovered she did not have carpal tunnel but had cervical disc issues and needed a cervical fusion. She wasted over a year being treated for the wrong thing, while the delicate spinal nerves were left in a compressed state.

    As you well know, you need a new MRI to see what is going on in your lumbar spine. You just need to figure out how to make that happen.

     
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    Old 02-22-2019, 07:57 PM   #38
    jrwest100
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    Re: Denied MRI

    Well,got a call saying mri is finally approved.yes,im. glad,but it would have been so much easier to schedule when i was out of work.

     
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    Old 02-23-2019, 11:02 AM   #39
    teteri66
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    Re: Denied MRI

    Do you have a date? Soon, I hope! Will you then see a spine surgeon once you have the MRI?

     
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    Old 05-18-2019, 04:04 PM   #40
    jrwest100
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    Re: Denied MRI

    [QUOTE=teteri66;5492510]Do you have a date? Soon, I hope! Will you then see a spine surgeon once you have the MRI?[/QUOTE

    Hi, finally got mri done.and the results are "congenitally shortened pedicles" which I guess is a stenosis, thickened ligamentum flavin,and various disc bulges and degenerations.doesnt sound like something surgical,but certainly not anything that's ever going to get better either.
    Going to call for a f/u appt,I assume no news is "good"news,but who knows.

    It's so hard to tell what is back probs vs what is knee probs etc. Mri said possible osteopenia in the marrow too.

    Wish me luck. Thanks!

     
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    Old 05-18-2019, 07:55 PM   #41
    teteri66
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    Re: Denied MRI

    Well, that certainly took long enough to get the MRI.

    I would not assume that surgery is out of the question. It al depends on whether any of these things are causing nerve compression severe enough to warrant surgery.

    The shortened pedicles indicate there is most likely stenosis throughout the spinal column not just at one or a few segments as it would be with a degenerative stenosis. They do keep the central canal from being as wide as it would be otherwise.

    It is worth following up to receive a proper diagnosis and a plan for treatment going forward.

     
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