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Insurance denying MRI

In 2011 I hurt my back. At that time I was a trucker doing long haul. I came off the rd and quit my job. The pain was too much to bear at that point. Found out I had herniated, slipped,cracked and damaged nerves in my disks. The doc's really didn't want to do anything at that time. They were just trying to find a quick fix. I had the epidural shots, that didn't work. In the process I had found out that I had lower neuropathy. Along with a lot of other health issues. One by one the doc's had washed their hands of me. Since the pain meds and what they called treatment wasn't working.. after 6 mths of bouncing around 4 to 5 doc appointments a week. I was mentally and physically drained. I was being told by my specialist that there was no reason I should be in so much pain and that he highly doubted that I had neuropathy considering my age. I was told that my back would fix itself within 2 yrs just give it time. At that point I had no desire to seek another doctor.
3 yrs later.. my condition has only gotten worse. since Dec I've ended up in the hospital twice. I can barely walk on my own. Everyday is a battle to do something simple as getting out of bed or to even do the dishes. I constantly deal with numbness in my hands, limited movement and can no longer raise my left arm above my head. I'm angry and frustrated. So I went back to the doctors after seeing me they immediately wanted to set me up with an MRI. But the denial came quick but I was however approved for an xray. Which didn't show much other than the same disks are now arthritic. So I was referred to a specialist. His request was denied. So he figured if I went to physical therapy that would help with the approval. So in the meantime I've been going to physical therapy and have sought a neuro doc. They have ordered an upper and lower EMG and MRI. This order was put in 2 wks ago. Called today after not hearing from the doc office on whether or not it was approved. And found out that the MRI is still pending.
I've never been in this situation. Don't know what my next step should be to resolve the situation. But at this point everything is on hold because no one can really do anything without an MRI. Can someone help me better understand this? Thank you..


  • dilaurodilauro ConnecticutPosts: 9,833
    come from 99.9% the doctors lack of providing adequate rationale and justification for the diagnostic test.
    Sure, MRIs are more expensive, but if you doctor believe hat your situation warranted a MRI, then I would only have to imagine he/she would provide that.

    I have read dozen of threads here plus from hospital information, the denial of any diagnostic test lies with your doctor. Either they have not provided enough paper work to justify the tests or they do not believe the tests are necessary.

    From reading your thread, I can not find any sound concrete problem. No validated herniated disc, no disc pressing on a nerve root, so that is good news for you. The one item you mention, neuropathy has become so much of an overused term, it can be identified to a patient when nothing else is found. Neuropathy can also result from certain metabolic disorders, infections, malignancy, inflammation, vitamin deficiencies, toxins, inherited conditions, and other abnormal processes.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • tests can be ordered. Everything must have a justifiable medical reason for ordering the test.......There are steps that must be taken, when it is not a medical emergency, and getting through them is a bit frustrating...this thread might help you to understand the process, not make it easier to get through but understand why.
    The xrays are one of the early steps, they are used to check alignment of your spine , for fractures, to rule out cancer or other obvious bone related disorders.
    They do not show the discs between the vertebra.
    This link may help you to understand the steps to getting treatment for chronic spine pain.

  • I had the same problem . I could not get an MRI for my back pain and I knew I needed one. I found a place that did the MRI , for 350. Cash. Then I found a cash only minor emergency clinic. The doctor there called in the prescription for the MRI.
    I had to pay 70.00 for the doctor visit . Once I had my MRI no one could deny my problem. I had two ruptured discs and a bulge in L5. Only with my paid for cash MRI did I get the insurance paid medical help I needed
    Best Wishes, Ruthann
  • i have never been denied an mri. but the doctors are the ones that order them not me. once i asked and the doctor said it was too soon for one. they like doing at a minimum once a year or a year and a half. you do need justifiable info to order one though. a doctor cant just order one because he feels like it. he needs to give a good reason such as possible herniation of a disc or maybe stenosis causing pain. but like i said i have never been turned down for one and i have had a lot of them the last one was about 2 years ago when my disc broke on the L3. i had that and an x=ray to see what was up. if you have a ppo it will take an act of you know who to get an mri. they wont even give out antibiotics let alone an mri. i will never and i mean never use a ppo. in a month or so i will get medicade upon retiring and i have to go over the book they sent me. my district paid for it every month so i have never had to pay out of pocket for medicade. one of the benefits of working. my father in law had all jobs that were temp because he wanted it like that so he had to pay for it out of pocket himself. i told him he was stoopid to do that but he would not listen. so now he is complaining that they increased his payments. oh well, dont listen to me.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • diagnostic test. There needs to be a medical basis for one.......the symptoms that the patient complains of, any signs of nerve impairment, or worsening of symptoms , and the doctor's examination, after ruling out the easy causes , will determine whether or not a person is in need of an MRI.....MRI's can run into the thousands of dollars, depending on the reason it is being ordered, so insurance companies are not going to just fulfill the patient's request for one , without medical basis.
    Everyone forgets that back pain complaints are the number one cause of visits to doctors.......the large majority of them will resolve on their own ,with little to no treatment or intervention medically necessary...for those who's symptoms don't resolve , then there are steps that need to be taken to attempt to rule out muscle fatigue, wear and tear, aches and pains, before ordering further testing and evaluation.
    A little patience , which I realize is not always easy , goes a long way when it comes to treating back pain........You didn't get there overnight in most cases, and it is not going be overnight to find out what may be causing it.
  • jenna410jjenna410 nunyabusinessPosts: 1
    Sandi, patience?  The poster said he/she has been suffering with chronic pain for 3 years and is barely able to function.  I think he/she's been waiting for longer than "overnight".  I'm dealing with similar issues, and they are so debilitating I don't even drive or go out much anymore.  They are NOT resolving on their own and 2 or 3 years of suffering without getting the proper tests is simply unconscionable.
  • LizLiz Posts: 7,832
    edited 09/20/2016 - 1:46 AM

    This is an old discussion created by a member  that didn't come back to the forum so I am closing it.

    You can search for articles on this subject or I suggest you create a new discussion

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
This discussion has been closed.
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