MRI denied by insurance company.

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tweetybird
tweetybird Member Posts: 815
edited June 2014 in Employment, Insurance, and Other Financial Issues
MRI denied by insurance company.
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  • tweetybird
    tweetybird Member Posts: 815
    edited July 2011

    Hope I'm in the right area for this one. I'm at my 5 year cancerversary today. I'm due for my follow up MRI on 8/4, and need to have a unilarital mamo 2 weeks after that, due to my mamo in February. It looks like there's scar tissue build up, so they want to do a follow up on that.

    On the 22nd my insurance company called, saying the outside firm that that use for pre-authorization of MRI's denied it, due to no history of breast cancer and scarring!!!!! It took an entire week to finally talk to a person at my doctor's office, and they didn't even send over additional information that both myself and the insurance company left a number of messages on. This makes no sense whatsoever, since I had the same insurance when I was DX with BC. You would think they would be able to look it up on their files.

    Has anybody ever had this happen to them before, even though they had previous MRI's done and approved in the past? The insurance company said as soon as they have the paperwork, they will rush it thru, but it could take up to 2 weeks. I'm not sure if I should cancel my original appointments, and reschedule, pay the $5,000 out of pocket, or just not go at all. I would greatly appreciate any sort of help with this!!!!

    Tweety

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  • ATeamNana
    ATeamNana Member Posts: 464
    edited July 2011

    Wow ...that is incredible...I agree they should have paperwork showing your previous information.That is tough call....I would not be able to come up with $5000.00 out of pocket so I'd be in a heap of trouble....Hope they get iit figured out and pre-authorize for you.  So sorry you have to deal with that.  I do not have any experience with this. Hope someone comes along that can help you out.

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  • tweetybird
    tweetybird Member Posts: 815
    edited July 2011

    Thanks for the reply Nana! Glad I'm not the only one scratching my head. I was thinking about calling my oncologist to see if she can pull some strings. My breast surgeon is the one who is sending me for the MRI.

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  • Chickadee
    Chickadee Member Posts: 4,467
    edited July 2011

    A call to your state's insurance commissioner would be in order.  Tends to make things happen faster I expect.

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  • tweetybird
    tweetybird Member Posts: 815
    edited July 2011

    Thanks Chickadee!!! I'll look into it today.

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