Prior Authorizations (1 Viewer)

tomwaits

Frontier Psychiatrist
Joined
Aug 1, 2002
Messages
16,625
Reaction score
6,686
Age
45
Location
Pflugerville, TX
Online
I went through the authorization thing fairly recently.
I tried to go to my doctor a few months ago with a re-occurring abscess issue and was told by the office that because I had a fever, I had to go to their urgent care clinic instead. (Covid policy was that if you had fever or any other potential Covid symptoms, you could not see your regular doctor and had to go to urgent care)

Urgent care looked me over and I told them I previously needed a MRI for the surgeon to figure out the cause. They agreed and told me I need to get one immediately.
They scheduled an appointment with the surgeon for 2 days later.

The MRI people said they couldn't do it unless I got an insurance authorization.
The Urgent Care clinic said they don't do authorization requests. (Which made me question why they would tell me to get something they can't authorize)

I contacted the surgeon's office to see if they could to it, but with the bureaucracy on the doctor office side and the insurance company side, I was being told it would be several days before I could get authorization for something the urgent care doctor told me to get the same day (yet could not ask insurance for authorization).

I scheduled the MRI for the next morning anyway and told them I would look into self-pay as I wanted to make sure the surgeon had the results when I went in to see him. (I was having a good bit of pain at this point)

I went to the hospital for the MRI the next day and they told me it was cancelled because of no authorization. I told them I want to just pay for it, but I didn't know how much it was. MRI people had no idea either. They sent me to the billing dept at the hospital.

Billing people didn't know how much it would be either and asked my what the medical codes were for the MRI (like I would know this).
I called around and had to track down the codes and eventually one of the people I talked to also had the price.

I went back to MRI place and told them I would just pay it if authorization did not go through, and they agreed to do it.

The authorization did eventually go through late that day (surgeon's nurse was awesome in getting this expedited), but I was pretty disappointed with the whole process.

Also note the doctor office, urgent care, surgeon, and MRI hospital were all in the same medical system company.
 

Paul

Professional
Joined
Oct 20, 2004
Messages
17,038
Reaction score
13,144
Age
45
Offline
“MRIs and CT scans are very expensive” - is the answer I’ve heard most frequently.
 

Dago

Veteran
Joined
Jan 10, 2007
Messages
7,372
Reaction score
11,505
Offline
Just paging you as you had an OBGYN review your case for authorization.
No it was a pediatrician

My insurance told my surgeon that the ALIF with marrow aspiration was considered experimental stem cell research despite the fact that the same insurance had approved the procedure for his other patients. When my surgeon tried to an appeal, the doctor they got to review my case and tell my surgeon (who is nationally known) was a pediatrician

Still pisses me off to think about it
 
Joined
Jul 19, 2001
Messages
27,238
Reaction score
72,950
Location
Earth
Offline
“MRIs and CT scans are very expensive” - is the answer I’ve heard most frequently.

For example, the average cost in the U.S. for an MRI scan was $1,119, compared to $811 in New Zealand, $215 in Australia and $181 in Spain. However, data showed that the 95th percentile in the price of this procedure in the U.S. was $3,031, meaning some people are paying nearly $3,000 more for a standard MRI scan in the U.S. than the average person in Australia and Spain.
 

CapitalCitySaint

99% Practice; 1% Theory
Joined
Jan 4, 2013
Messages
6,137
Reaction score
14,288
Location
The Whale’s Box
Online
No it was a pediatrician

My insurance told my surgeon that the ALIF with marrow aspiration was considered experimental stem cell research despite the fact that the same insurance had approved the procedure for his other patients. When my surgeon tried to an appeal, the doctor they got to review my case and tell my surgeon (who is nationally known) was a pediatrician

Still pisses me off to think about it
A pediatrician is only slightly better than an OBGYN review. LOL
 
Joined
Jan 29, 2019
Messages
1,913
Reaction score
1,472
Location
Florida
Online
Insurance companies, doctors, and the medical system are businesses, once you accept this, it all makes sense.

If your medical insurance won't cover it, you have options. I heard you can get stuff down in Mexico quick and pay for it in cash at a lot lower expense, than the U.S..

I would recommend doing your own research on whatever a doctor recommends, doctors make mistakes sometimes, so it doesn't hurt to ask questions.
 

Create an account or login to comment

You must be a member in order to leave a comment

Create account

Create an account on our community. It's easy!

Log in

Already have an account? Log in here.

Users who are viewing this thread

 

New Orleans Saints Twitter Feed

 

Headlines

Top Bottom