Odds MRI Gets Denied by Insurance

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kista
kista Member Posts: 25
edited September 2018 in Diagnosed and Waiting for Test Results

So, I was diagnosed yesterday. But can't meet with my surgeon or Oncologest until I have my MRI. The Patient Services lady set everything up immedialy following my doctors appointment. We sat in her room for 30 mins and scheduled everything. I get home and she calls back to say they have to move all my appointments to late next week because of insurance will take a week even though they're submitting the Prior Authorization (PA) as "Urgent." 

I call my insurance and they actually hadn't submitted any of the paperwork or actually called them even yet (as they'd stated). So apparently they submitted the PA today. I called insurance and they said it wasn't marked as urgent (que 37 year old bawling in the school parking lot waiting for her kids) and they have 2 weeks to approve the MRI. I call the clinic and they said they couldn't submit as urgent so we need to push my appointments out another 2 weeks OR I can sign a waiver saying I'll pay approximately $2,175 out of pocket for the MRI if it's denied by insurance. If I choose to sign the waiver my original appointment for tomorrow will be honored.

I told them fine and I'd sign on it. But, what are the odds my insurance would deny it?

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Comments

  • Michi
    Michi Member Posts: 98
    edited September 2018

    no chance your insurance will deny this, the first step in many’s diagnosis, or post diagnosis is an MRI, I wouldn’t worry about it and I would sign the waiver to get things moving. So sorry to hear about your diagnosis, I’m 35 and was diagnosed with pre-cancerous cells but given the prognosis and risk opted for a full mastectomy with reconstruction. Best of luck; this website was and often times still is, invaluable

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  • kista
    kista Member Posts: 25
    edited September 2018

    Thank you! I didn’t assume it would, especially with my sister being diagnosed with Stage 4. But my hubby was a bit worried that they might just to be jerks since we didn’t wait for approval. According to the policy it has to have a prior authorization to be covered.

    At the same time he’d rather just pay for it then sit and wait any longer.

    Glad you got yours taken care of before it really hit! How did you find out so early

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited September 2018

    I don't understand why they can't submit it as urgent. You have a cancer diagnosis. This exam is important for staging and treatment planning. Good grief! I'd be crying, too.

    It will be covered. I would worry a bit about the "pre-approval" stuff though. You may need to make some more phone calls to get this fast tracked.


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  • Michi
    Michi Member Posts: 98
    edited September 2018

    Hi Kista-

    Sheer luck/grace of god I found mine. I had a friend diagnosed so I was on high alert. Noticed one breast larger than the other (which doctors swear to this day had nothing to do with it all) led to a mammogram (after much pushing) normal, but I wanted more reassurance since I’m dense tissued. Pushed for the MRI and they found the cells during a biopsy. It’s been a ride, but glad to have discovered it before it was something.. sorry for your sister, BC hitting young people is just scary.

    Ps- if the insurance gives you trouble you can fight it. PM me if the time comes and you have issues and I’ll explain what to do.

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  • kista
    kista Member Posts: 25
    edited September 2018

    I don’t understand either. They told me yesterday they did it and submitted as urgent. I called insurance just to try and move things along and they told me the paperwork wasn’t there! Called the clinic and they said, yeah we are waiting for the doctors notes and final authorization but it’ll get submitted today. Called today and they didn’t submit til today and it’s not urgent.

    Seriously... I lost it. I’ve been on the phone trying all day to straighten it out and just saying screw it and signing the waiver tomorrow to make us liable if it’s denied. I don’t know what else to do

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  • kista
    kista Member Posts: 25
    edited September 2018

    Wow! So glad you found it when you did! Thank you for offering to help. I’ll certainly be in touch if I find out it’s denied

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  • beach2beach
    beach2beach Member Posts: 996
    edited September 2018

    Just speaking from the view of someone who used to work in Dr's office, they can call and get it pretty quickly. Usually if they get the dr on the line, he/she explains the need for it (not everyone has an MRI when or after being diagnosed) they can have it authorized within the day. I would not worry about it getting denied. Put yourself first here, and get the appt and go. If for some strange reason it gets denied, you can fight it..and even then, there ware ways that even if you were liable you could get much of the charge dismissed.

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  • gb2115
    gb2115 Member Posts: 1,894
    edited September 2018

    I agree with previous poster, if your doctor's office gets on the phone with insurance they can get fast (possibly immediate) approval. We do that at work all the time for medication authorizations. Sending the paperwork in takes forever, but the phone is quick.

    I would be surprised if your MRI isn't covered.

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  • kista
    kista Member Posts: 25
    edited September 2018

    Thanks all. Guess I’m just gonna roll with it. Appointment was for 1 but they just called and had a cancellation so I’m heading there in a few.

    It is what it is at this point and I’ll have to fight with them on a future date if need be!

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