Prior Authorizations (1 Viewer)

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.
 
“MRIs and CT scans are very expensive” - is the answer I’ve heard most frequently.
 
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
 
“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.
 
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
 
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.
 

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