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I am making this post on behalf of my friend.

She went to a neurologist back in December 2009 because she had been having headaches problems for a long time now now. The doctor ordered an MRI after encouragement from her (he wanted to say that she was having migraines). My friend made sure that it would be covered so she called her insurance company, the lab, and even the neurologist said it would be covered. Fast forward to March 2010 and the bill still has not been paid. Now the lab and insurance company are singing a different tune. The lab has already sent a claim, but the neurologist seems to have disappeared off the face of the earth. He still has not sent an insurance claim and has ignored all phone calls, including calls from the insurance company. My friend has the "raw data" from the MRI and has gotten it read from another neurologist as a favor. There is indeed something ominous about the results and further testing needs to be done. She cannot proceed though unless the fees to the MRI are paid, but she needs to proceed, before further damage insues.

1. Who is responsible for the bill in this case?
2. Can she sue the neurologist for negligence? She needs immediate care based on the diagnosis and this guy's action is causing this delay.

Thank you for reading my novel and all input and personal experiences would be appreciated. Thanks.

PS No pics of my friend unless it is of the MRI.

Member Summary
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This is a good question for OP, not me. Read my posts, I have been telling him/her to get the medical issue resolved.

So... (more)

nycll (Mar. 20, 2010 @ 7:26p) |

She requested the MRI... it probably was not medically necessary or the physician would have ordered it. That is why th... (more)

troutmd (Mar. 22, 2010 @ 3:14a) |

What's up with your feeling the need to make personal attacks like that?

ThePessimist (Mar. 22, 2010 @ 9:40a) |

Quick Summary is created and edited by users like you... Add FAQ's, Links and other Relevant Information by clicking the edit button in the lower right hand corner of this message.
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Sounds like it was ordered by the doc and it was out of medical necessity. I'd focus on finding a different doc who can read the scan and take care of any issues.

The bottom line is that your friend is responsible for getting the bill paid. If she can't get her insurance company to pay, then she should try to negotiate with the provider to reduce the amount owed or work out a payment plan or something.

Not sure how this will play for her but in a less serious situation I told a lab the doctor ordered a test and they should collect from him.
(In my case I though the test was not medically necessary).

Why can't she get treated until the MRI bill is paid? She is paying for insurance are they denying her necessary medical care?

BrlDsguise said: Not sure how this will play for her but in a less serious situation I told a lab the doctor ordered a test and they should collect from him.
(In my case I though the test was not medically necessary).

Why can't she get treated until the MRI bill is paid? She is paying for insurance are they denying her necessary medical care?


I believe they are refusing to process other services until this claim has been taken cared of. I don't see how my friend is responsible for paying a bill when there were THREE parties that verified that it would be covered. That sounds like bait and switch to me.

I am also interesting in suing this doctor for malpractice as he is delaying treatment in an urgent situation.

i3ighead said: I am making this post on behalf of my friend.

She went to a neurologist back in December 2009 because she had been having headaches problems for a long time now now. The doctor ordered an MRI after encouragement from her (he wanted to say that she was having migraines). My friend made sure that it would be covered so she called her insurance company, the lab, and even the neurologist said it would be covered. Fast forward to March 2010 and the bill still has not been paid. Now the lab and insurance company are singing a different tune. The lab has already sent a claim, but the neurologist seems to have disappeared off the face of the earth. He still has not sent an insurance claim and has ignored all phone calls, including calls from the insurance company. My friend has the "raw data" from the MRI and has gotten it read from another neurologist as a favor. There is indeed something ominous about the results and further testing needs to be done. She cannot proceed though unless the fees to the MRI are paid, but she needs to proceed, before further damage insues.

1. Who is responsible for the bill in this case?
2. Can she sue the neurologist for negligence? She needs immediate care based on the diagnosis and this guy's action is causing this delay.

Thank you for reading my novel and all input and personal experiences would be appreciated. Thanks.

PS No pics of my friend unless it is of the MRI.
How did your friend confirm coverage of the MRI, in writing? Did her insurance company require a pre-authorization for the MRI. She could confirm the MRI coverage requirement by reading her policy.

My insurance company requires a pre-authorization for an MRI. I did not know this, but my neurologist's office did, and he had his office request same. My neurologist stated an MRI can cost $2k+, which I did not believe. (My mri ended up billing at $2600, insurance allowed less than $500).It can take 2-4 weeks (my pre-auth took 5+ wks) to receive the pre-auth from your insurance company, and then you arrange an appointment for the MRI.

What exactly does her EOB state for denial of coverage of the MRI?

i3ighead said: My friend has the "raw data" from the MRI and has gotten it read from another neurologist as a favor. There is indeed something ominous about the results and further testing needs to be done.

I'm NOT following you. MRIs are not "read" by neurologists, they're read by radiologists. A PCP, neurologist, internist, etc. may also want to look independently at the MRI to confirm any reported findings. Your friend should be MOST concerned right now about getting appropriate followup and further evaluation. Considerations of the insurance claim and possible malpractice are secondary.

Good Luck,

I love our health insurance system!

i3ighead said:

PS No pics of my friend unless it is of the MRI.


count me as an interested party...

i3ighead said: My friend has the "raw data" from the MRI and has gotten it read from another neurologist as a favor. Your friend should have been given a CD from the radiology center. The CD should have her MRI images/study and the Radiologist's comments. She should be able to take this CD to another doctor for further treatment recommendations.

All the insurances that the expense would be covered are worthless. She is responsible for paying the bill. You have zero claim for malpractice, any doctor can refuse any non-emergency treatment to anyone for any reason.

She can have the data read by whoever she wants.

Why can't she proceed? Just go to a different MRI facility.

hi i had plenty of these done for neck injury.


doctor says goto specialist. Primary Care Doctor is never qualified to order MRI. Doctor's office refers to Specialist. Specialist office locates MRI facility that is of good quality (never go to the burbs for medical work). Specialist's office calls insurance company to get pre-auth and schedules appointment with MRI place. You go to MRI place. They then again check insurance validity. Spend 30 minutes without moving in nice GE unit. Open-Air and the super tiny GE = too poor(skip if possible). The newer models take a 400lb man no problem.

So the operator is never qualified to read it.

Radiologist does his best guess analysis and Specialist also reads it.

Everything is good. Copay Doctor. Copay Specialist. Copay MRI (so like $80 out of pocket).

Aetna OPEN HMO.

Trust me - do not use open-air - try to avoid the smaller GE units it's a like being in an elevator for 30 minutes with loud clacking noises (with earplugs) that is barely the size to fit a 180lb man. The big GE's are nice less stressful.

Do it any other way - yes you will get screwed.

Extra information just for those who've never had one before. p.s the MRI's cost was like $450 paid by insurance to facility - i think they wanted $1500 but you know that is how they work. pennies on the dollah

What is the insurance company's excuse for not paying for the MRI? Unless the lab is affiliated with the neurologist somehow, I would think they would submit their own claim to the insurance. Is it because the neurologist didn't fill out the paperwork to pre-authorize it? Does the insurance require pre-authorization? If the last 2 questions are yes, then I would go to the neurologist's office (no phone calls) and get it straightened out. Sit in the waiting room from open to close if you have to, and tell his prospective patients how he doesn't file his insurance claims.

Frankly, 4 months is not a long time in the world of healthcare insurance billing (gotta love our system). If the neurologist has truly skipped town, I think I would sit back and twiddle my thumbs until a collection notice comes. The lab and the insurance company might work out something if it doesn't look like they are getting any money from the patient. I don't really understand why this is holding up further care. Your friend has got the raw data of the MRI. If we all waited for the insurance companies to pay our bills before continuing treatment, our healthcare system would be in a bigger mess than it is now.

From my experience, unless the MRI shows some abnormality, it is probably migraines. There are prescription medications that may help prevent the frequency of migraines. Recognize the triggers (it is different in every person) and avoid them when possible.

Is the neurologist's office in-network? Is the lab that performed the MRI in-network? It matters. Failure to obtain pre-authorization by an in-network provider is supposed to leave them, not the patient on the hook.
Check what the EOB says. What is the patient responsibility section saying? If it's zero, in-network providers must comply and cannot bill the patient for the balance. If the in-network provider refuses, call the insurance company to notify them of a possible violation of the provider's contract.

Your friend can take the MRI data to a different neurologist/facility to get follow-up care. If there are good in-network neurologists that accept new patients, that would be the preferred (financially speaking) option. The new provider can also request your friend's medical records from the former neurologist/lab.

I still don't understand the story. Who is sending the bill that needs to be paid? If the neurologist has "disappeared off the face of the earth," then how is he also pursuing a bill? If it's a medical center or billing service that is pursuing the bill, then she should be able to call them and have them submit a claim on the neurologist's behalf.

I also don't understand why this unpaid bill should keep her from getting treated. She's not going back to that neurologist anyway, if he's "disappeared." Why doesn't she just make an appointment with a different neurologist? Under HIPPA, a doctor or office can't even stop her from getting a copy of her medical records, regardless of her payment status.

ThePessimist said: I still don't understand the story.

Agreed. I'm no slouch when it comes to insurance matters and have contacts with extremely deep expertise in this kind of claim situation. But I'm not following this story at all. Seem like details left out and other things possibly misconstrued. And an abundance of the always popular extraneous details.


Generally resolving this kind of thing requires: looking at the *exact* plan wording; determining network impacts (in-network, out-of-network, etc.); carefully reviewing the detailed bills and Explanation of Benefits (EOB); calling to verify the chain of events.

I could guess as to what I *think* actually went on here, but I don't want to add to the already sizable pile of unsupported speculation.

ThePessimist said: Who is sending the bill that needs to be paid? The MRI center
If the neurologist has "disappeared off the face of the earth," then how is he also pursuing a bill?Not sure what he is doing, but that is a much smaller bill compared to MRI.
If it's a medical center or billing service that is pursuing the bill, then she should be able to call them and have them submit a claim on the neurologist's behalf.The neurologist needs to submit some paperwork to support the medical necessity of the MRI. 99.9% of doctors are very helpful. But some of them are not. This particular one may have a personal problem (like a mid-life crisis) or might just be a general jerk.

I also don't understand why this unpaid bill should keep her from getting treated. She's not going back to that neurologist anyway, if he's "disappeared." Why doesn't she just make an appointment with a different neurologist? Under HIPPA, a doctor or office can't even stop her from getting a copy of her medical records, regardless of her payment status.Yes, that is what I recommend too. Take care of the medical issue first. Take care of the first MRI bill second.

If OP is still around, I am curious to see which insurer and which plan this is.

lakshmi111 said: Your friend can take the MRI data to a different neurologist/facility to get follow-up care.

The plan may or may not pay for that second facility if it deems: the necessary procedures have already been performed; the procedures at the second facility would essentially duplicate those at the first facility; the results of the procedures at the first facility do not demonstrate a medical need for the procedures to be repeated.

Lets break this down.
I know its easy to try and sue the doctor. He has money (that he has worked his life for) and you think its easy pickings. Its easier to sue the doc since its not as ominous as going up against your insurance company. The insurance company is the party that you are paying to cover your medical cost...if you want to sue for negligence then sue the insurance company. In the end your friend is responsible for paying the bill until its all settled with the insurance company. The doc's job is to evaluate the patient, order tests that he feels are needed, and if he continues to treat you then to evaluate the results from tests and initiate a treatment protocol.

The doc's decision to not continue to treat you is his choice. Unless your friend is dying in the middle of his office he can decide that he is not the best person to treat you. Docs are human. They should have the ability to have a choice. Maybe there is nothing he can do, maybe its a neuro-surg or heme-onc, or surg-inc issue.

If you are actually concerned about your/your friends health and welfare then you can take the data from the test, or the images from the test to another physician. You are legally allowed to take the actual images (they may charge you like $15 to burn it to disc). If there is something ominous then you can get treatment if treatment exists from elsewhere. At this point if its an actual emergency then go to the ED and get admitted to the hospital.

It seems more like you are trying to find someone to point fingers at and not taking responsibility for your own health. If there is a medical issue address it, rather than obsessing over why this physician has disappeared. In this economy he might have just closed up shop, he might be on vacation or like any other human may have a family emergency or health issues to deal with.

Pakman0209 said: The doc's decision to not continue to treat you is his choice. Unless your friend is dying in the middle of his office he can decide that he is not the best person to treat you. Docs are human. They should have the ability to have a choice. Maybe there is nothing he can do, maybe its a neuro-surg or heme-onc, or surg-inc issue. You are wrong. If the MRI discovers a tumor or something like that, the doctor really doesn't have a choice of stop providing care, by both professional and legal standard. Obviously the hurdle to clear is a reasonable one--he can simply tell the patient that something looks wrong but it is beyond my expertise you should go find a different doctor.

But when there is something wrong but saying nothing about it is gross negligence.

sayhey said: I'm NOT following you. MRIs are not "read" by neurologists, they're read by radiologists. A PCP, neurologist, internist, etc. may also want to look independently at the MRI to confirm any reported findings. Your friend should be MOST concerned right now about getting appropriate followup and further evaluation. Considerations of the insurance claim and possible malpractice are secondary.

Good Luck,
I completely agree with your priority. But just about the radiologist vs the test ordering doctor, sometimes the radiologist is very hard to reach and he is only supposed to convey the test findings back to the doctor who originally ordered the test, and the original doctor is the one who is supposed to tell the patient. But every once a while you ran into a radiologist who is not afraid enough of being sued (who will tell you the result).

i3ighead said: I am making this post on behalf of my friend.

She went to a neurologist back in December 2009 because she had been having headaches problems for a long time now now. The doctor ordered an MRI after encouragement from her (he wanted to say that she was having migraines). My friend made sure that it would be covered so she called her insurance company, the lab, and even the neurologist said it would be covered. Fast forward to March 2010 and the bill still has not been paid. Now the lab and insurance company are singing a different tune. The lab has already sent a claim, but the neurologist seems to have disappeared off the face of the earth. He still has not sent an insurance claim and has ignored all phone calls, including calls from the insurance company. My friend has the "raw data" from the MRI and has gotten it read from another neurologist as a favor. There is indeed something ominous about the results and further testing needs to be done. She cannot proceed though unless the fees to the MRI are paid, but she needs to proceed, before further damage insues.

1. Who is responsible for the bill in this case?
2. Can she sue the neurologist for negligence? She needs immediate care based on the diagnosis and this guy's action is causing this delay.

Thank you for reading my novel and all input and personal experiences would be appreciated. Thanks.

PS No pics of my friend unless it is of the MRI.


Did she see a neurologist in a 3rd world country or something? What kind of neurologist disappears from the face of the earth, they make bank if they're running their business properly.

Maybe he wasn't really a neurologist to begin with? Sounds fishy, I don't buy the whole story. It doesn't make sense unless the neurologist is a fraud or located in another country or your friend is not telling the whole truth and/or is lying about parts of it.

Why else wouldn't he bill her insurance? I don't know of any Dr who doesn't bill insurance or care to go after the patient for payment - instead he avoids both???

What kind of friend do you have who can go around getting MRI's read from neurologists as a favor? If she has a friend who is a neurologist, why didn't she see that person in the first place?

Has she bothered to even go down to the actual office where she was first seen and demand to speak to the billing and claims mgr about it?

Also, three months for an insurance company to pay on a "larger" claim is not uncommon. In my personal experience, it's taken up to 6 months for my insurance to pay out on claim larger than a regular checkup and even for a routine checkup the insurance didn't pay for 6 weeks. My kids immunizations didn't get paid for 2 months. It shouldn't be holding up her treatment.

Tell your friend to get out of her phone-calling comfort zone, physically go down to their office and stay there until she gets some answers. I know, I know, personal interfacing is scary these days and a lot of people are unfamiliar with talking face to face with another human being about serious matters but sometimes it's the only way to get results.

i3ighead said: BrlDsguise said: Not sure how this will play for her but in a less serious situation I told a lab the doctor ordered a test and they should collect from him.
(In my case I though the test was not medically necessary).

Why can't she get treated until the MRI bill is paid? She is paying for insurance are they denying her necessary medical care?


I believe they are refusing to process other services until this claim has been taken cared of. I don't see how my friend is responsible for paying a bill when there were THREE parties that verified that it would be covered. That sounds like bait and switch to me.

I am also interesting in suing this doctor for malpractice as he is delaying treatment in an urgent situation.


Yeah, I'm sure all 3 of them collaborated after they saw your friend and decided they were going to gang up on her and make her life miserable! I can just hear them in their sneaky, evil voices.

"Hey, we have this girl who has this MRI. Let's play a nasty joke and ignore her after she gets it done just to make her crazy!!! I know we said she's covered but let's change our minds just for fun and evil... Ha Ha Ha Ha Ha..."

Get real, not a bait and switch. You should ask her what the documentation said that she signed BEFORE getting the MRI that most likely stated SHE would be responsible for whatever portion of the bill her insurance would not cover.

You sound a little suing happy. I thought you were asking for your "friend" but "you" are interested in suing for malpractice???

If all you're interested in is information on how to sue a Dr and win then you're in the wrong place, go talk to a lawyer - not Fatwallet Finance.

nycll said: ThePessimist said: Who is sending the bill that needs to be paid? The MRI center
Where did OP say that? How could the MRI center prevent her from getting further treatment? Even if she needed more MRIs, she could go to a different center. (It might involve a drive, but hey, it's her life we're talking about.)

If the patient insisted on the MRI despite the neurologist's recc that one is not needed and so noted in the chart, I can well imagine the insurance company balking at paying. If it turns out that the MRI found something important, I suggest filing a dispute with the insurance company. At this point, the burden of proof is going to be on the patient to show that the neurologist was wrong in not ordering the MRI at the time.

As for suing: mistakes != malpractice. Negligent, below standard of care mistakes are malpractice.

Sounds more like the "neurologist" really a pain medication doctor who required the patient get an MRI before being treated.
A lot of details have been left out by the OP.

ThePessimist said: nycll said: ThePessimist said: Who is sending the bill that needs to be paid? The MRI center
Where did OP say that?
In the OP, lab means the MRI center.
How could the MRI center prevent her from getting further treatment? Even if she needed more MRIs, she could go to a different center. (It might involve a drive, but hey, it's her life we're talking about.)This is a good question for OP, not me. Read my posts, I have been telling him/her to get the medical issue resolved.

So what's up with being so slow today? First you failed at understanding the yield curve in the forward libor thread, now you are plainly failing reading???

i3ighead said: The doctor ordered an MRI after encouragement from her (he wanted to say that she was having migraines).



She requested the MRI... it probably was not medically necessary or the physician would have ordered it. That is why the insurance company is not paying for it. Unfortunately, some doctors let patients dictate their care... then all of a sudden, its the doctors fault. There are very RARE indiciations for emergent MRIs.


Sounds like your friend needs to go pay her bills.

I'd like to know what the 'abnormal fingings are'. Lay people do not understand that if you scanned 100 people from head to toe, I bet nearly everyone would have 'abnormal findings'. An abnormal finding does not mean something MUST be done....

nycll said: ThePessimist said: nycll said: ThePessimist said: Who is sending the bill that needs to be paid? The MRI center
Where did OP say that?
In the OP, lab means the MRI center.
Yes, but he never said that it was the lab, MRI center, or equivalent that sent the bill. There would at least also be a radiologist involved who would usually bill separately. Given that she got her data but not the interpretation, it sounds as if it's the radiologist, not the lab, that's holding things up. Or that the radiologist sent the results to the neurologist, and the unpaid bill is actually irrelevant.

How could the MRI center prevent her from getting further treatment? Even if she needed more MRIs, she could go to a different center. (It might involve a drive, but hey, it's her life we're talking about.)This is a good question for OP, not me. Read my posts, I have been telling him/her to get the medical issue resolved.Yes, it'd be nice to hear from OP. But you're the one who is asserting that it's the MRI center bill that is in dispute, even though OP never explicitly said that.

What's up with being so slow today? First you failed at understanding the yield curve in the forward libor thread, now you are plainly failing reading???What's up with your feeling the need to make personal attacks like that?



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