Hi Everyone, hoping someone has some insight as I’m lost on what to do and can’t find a similar situation online.
I have been going to my doctor for almost a year now for horrible chronic neck pain and headaches that started out of the blue (27 year old male no other health issues that I know of). I have gotten blood tests, been referred to physical therapy, put on gabapentin. I’ve tried buying a standing desk, new bed, stretches exercises and nothing has worked. My doctor then referred me to a pain management clinic and ordered an MRI for the clinic to go over to take the next course of action.
I received a call from a department at my doctors office letting me know that my claim for the MRI was denied. I called insurance to inquire why and they said that based on what the doctor submitted, I did not meet one of the required conditions. I then asked what those conditions were and the first condition is that I have gone through at least 6 weeks of treatment by my doctor to no avail. The second was that I had symptoms necessitating the need for the MRI. I do meet one of the conditions (the first) so I inquired why it is getting rejected and my insurance told me that the notes do not specify that I did complete doctor referred treatment and that I need to contact them to file an appeal with the added information.
I called and spoke with one of the departments who handles claims and they said that they would talk to my doctor to get in touch with my insurance to resubmit it. This was last week. I just got a call from the same person letting me know that my doctor said that they went over all the information again and they feel it will not be approved so will not file an appeal….. I do meet one of the conditions which was verified when I talked to my insurance but the lady I spoke with said they are the middle man just relaying what my doctor said and there is nothing they can do and will not appeal. I asked for formal documentation from my doctor stating this but I don’t know what to do. I feel this isn’t right for my doctor to decide on behalf of my insurance especially when they are the one who referred me to get it. It really feels they are working against me. Any advice would be greatly appreciated. Thank you!
submitted by /u/notAlphaTangoFoxtrot
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Hi Everyone, hoping someone has some insight as I’m lost on what to do and can’t find a similar situation online. I have been going to my doctor for almost a year now for horrible chronic neck pain and headaches that started out of the blue (27 year old male no other health issues that I know of). I have gotten blood tests, been referred to physical therapy, put on gabapentin. I’ve tried buying a standing desk, new bed, stretches exercises and nothing has worked. My doctor then referred me to a pain management clinic and ordered an MRI for the clinic to go over to take the next course of action. I received a call from a department at my doctors office letting me know that my claim for the MRI was denied. I called insurance to inquire why and they said that based on what the doctor submitted, I did not meet one of the required conditions. I then asked what those conditions were and the first condition is that I have gone through at least 6 weeks of treatment by my doctor to no avail. The second was that I had symptoms necessitating the need for the MRI. I do meet one of the conditions (the first) so I inquired why it is getting rejected and my insurance told me that the notes do not specify that I did complete doctor referred treatment and that I need to contact them to file an appeal with the added information. I called and spoke with one of the departments who handles claims and they said that they would talk to my doctor to get in touch with my insurance to resubmit it. This was last week. I just got a call from the same person letting me know that my doctor said that they went over all the information again and they feel it will not be approved so will not file an appeal….. I do meet one of the conditions which was verified when I talked to my insurance but the lady I spoke with said they are the middle man just relaying what my doctor said and there is nothing they can do and will not appeal. I asked for formal documentation from my doctor stating this but I don’t know what to do. I feel this isn’t right for my doctor to decide on behalf of my insurance especially when they are the one who referred me to get it. It really feels they are working against me. Any advice would be greatly appreciated. Thank you!
submitted by /u/notAlphaTangoFoxtrot [link] [comments]Read Morer/HealthInsurance