Insurance refusing to pay for 'medically unnecessary' MRI??

[Anonymous]

MRI's should always be pre approved, outside of an emergency,

[Anonymous]

Oh crap, I just had two MRIs. I assume that the doctors orders deem them necessary. They are a diagnostic tool, so if the doctor needs them to determine what is wrong or to see how you are healing, you SHOULD be covered.

Fight it OP.

[Anonymous]

Who decides that it wasn't medically necessary? I'm always curious about their qualifications.

OP did your doctor try anything else first? A few sports injuries here, never needed an MRI. Doctor would have "liked" one though.

GO through the process anyway.

[Anonymous]

Anonymous wrote:Who decides that it wasn't medically necessary? I'm always curious about their qualifications.

OP did your doctor try anything else first? A few sports injuries here, never needed an MRI. Doctor would have "liked" one though.

GO through the process anyway.

It's well known that MRIs are over-used for back pain. Insurance companies study this stuff. Now, I've had stuff declined for not being "medically necessary" that was clearly bogus before. For example, my son had a seizure and Children's insisted that he be hospitalized overnight for an EEG, and then BCBS tried to claim the EEG was medically uneccesary. That was the legitimate fault of Childrens in failing to communicate with the insurance company, and we worked it out. (Well - Children's billing being so utterly useless, they eventually just forgave the bill to me entirely!)

But an MRI for lower back pain that you fail to get pre-approval for? Yeah, that's on you. ANY imaging procedure that is non-emergent, you need to check to see 1) if it's really necessary and 2) if your insurance will cover.

[Anonymous]

What is this pre-approval thing? I have called my insurance before when my daughter was having tubes done and similar routine kid surgeries to try to double check coverage and they absolutely refused to tell me ahead of time if it would be covered. Even if the doctor sent them the codes. They said that cannot be told before the procedure happens.

[Anonymous]

Anonymous wrote:What is this pre-approval thing? I have called my insurance before when my daughter was having tubes done and similar routine kid surgeries to try to double check coverage and they absolutely refused to tell me ahead of time if it would be covered. Even if the doctor sent them the codes. They said that cannot be told before the procedure happens.

+1. My recent surgery was preapproved by my insurance company. I have a letter to that effect. Yet when the time for bills came I am now fighting 20k$ worth of bills because Aetna deemed one aspect of the long surgery not medically necessary and I have been stuck with the sticker price for that portion. Preapprovals are an in principle approval. Doesn’t mean the insurance company will pay once they see the details.

[Anonymous]

“+1. My recent surgery was preapproved by my insurance company. I have a letter to that effect. Yet when the time for bills came I am now fighting 20k$ worth of bills because Aetna deemed one aspect of the long surgery not medically necessary and I have been stuck with the sticker price for that portion. Preapprovals are an in principle approval. Doesn’t mean the insurance company will pay once they see the details.”

Which is absolutely ridiculous. How are we supposed to do due diligence on being health care “customers” if we cannot get told what is covered or not.