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

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[quote=Anonymous][quote=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.

[/quote]

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.  [/quote]

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