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So I'll give the cliff notes version:

A few months ago, started getting headaches, head pressure.
Went to Primary, was told to try a couple things (diet, exercise)
A month ago, no improvement, went back to primary, was referred to a neurologist.
Two weeks ago, neurologist ran some basic tests and said he'd order a brain and neck stem MRI to rule out some things.
A week ago, neurologist's office called to schedule the MRI for today.
Got the brain and neck MRIs today.  Paid the $40 copay (deductible was already met, as confirmed by receptionist)
Got home, checked the mail, two letters from my health insurance company.  Both state "based on medical necessity, an MRI is not approved."

Since I just got $10k+ worth of procedures and an hour later learned the neurologist never actually got preauthorization before scheduling it ... what're the odds this bill will land on me?  I don't have much experience with high-dollar medical bills, wonder what others have experienced.

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Did you ask the neurologist to get preauthorization from your insurance before hand?

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Edited

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I asked about the preauth at the neurologist's appointment - I was told it would be obtained and an appointment set for the MRI. They tried to get the preauth.. they just didn't get it approved.

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Did you sign something that said you'd be responsible for any non-covered charges?

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I don't recall signing anything to that effect - but knowing how medical facilities operate it wouldn't surprise me if that's the case.

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The neurologist that ordered the MRI and the MRI center are the same place; they perform their MRIS in-house. I'm wondering if that's a good, bad, or neutral fact.

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CowbellMaster said:   Both state "based on medical necessity, an MRI is not approved."
They are basing that on the doctor's evaluations. Maybe if you got the doctors to rewrite those reports to include more serious symptoms and diagnosis the insurance co. would reevaluate and approve the bill. Do the MRI results show anything significant that only an MRI could show? BTW, I couldn't imagine any medical lab would go ahead with a $10K procedure without confirming the patient's insurance would cover it.

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atikovi said:   
CowbellMaster said:   Both state "based on medical necessity, an MRI is not approved."
They are basing that on the doctor's evaluations. Maybe if you got the doctors to rewrite those reports to include more serious symptoms and diagnosis the insurance co. would reevaluate and approve the bill. Do the MRI results show anything significant that only an MRI could show? BTW, I couldn't imagine any medical lab would go ahead with a $10K procedure without confirming the patient's insurance would cover it.

  No idea what the MRI shows, I just had it done 3 hours ago.  My followup w/the neurologist isn't for another 2 weeks.  I suppose I'll know how they plan on handling it when I call them tomorrow.

I'm pretty surprised this happened as well.  The receptionist was able to see we hit our deductible so I'm assuming she ran a report on our coverage, you'd think they would be able to find out authorization info electronically as well.  I'm not sure whether preauth info would be available to them any faster than it would be to me - assuming I got my denial letters today, they should have also received the same documentation at least by today's mail which was before my procedure at 4PM.

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OP: Where did you get the 10k number? That sounds awfully high and those non-hospital MRI centers are a lot cheaper than hospital ones, from my experience.


ETA:  Average cost per a gov study is $2,611 in US for MRI, nowhere close to 10k!

 

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I guess I just threw a round number out there - I see avg Brain MRI as being higher than that.

Anyways, it's higher than the $40 copay I was told by the receptionist was my responsibility. Suppose I'll find out tomorrow how much they think it costs!

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CowbellMaster said:   I guess I just threw a round number out there - I see avg Brain MRI as being higher than that.

Anyways, it's higher than the $40 copay I was told by the receptionist was my responsibility. Suppose I'll find out tomorrow how much they think it costs!

  The neurologist spent at least 4 years in college, 4 years in medical school, and at least 3 years in residency, so aren't you supposed to be appreciative that he was able to fit you in his schedule for only $10k?

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cowboyBill said:   
CowbellMaster said:   I guess I just threw a round number out there - I see avg Brain MRI as being higher than that.

Anyways, it's higher than the $40 copay I was told by the receptionist was my responsibility. Suppose I'll find out tomorrow how much they think it costs!

  The neurologist spent at least 4 years in college, 4 years in medical school, and at least 3 years in residency, so aren't you supposed to be appreciative that he was able to fit you in his schedule for only $10k?

  What does that have to do with the cost of the MRI? The neurologist isn't getting $10K.

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I called the office today and was told they verified the authorization was approved before scheduling the procedure. Hmmmm

So then I called my insurance company and was told authorization was, in fact, approved! Hmmmmmmmmm

Faxed them the authorization declined letters. Turns out the medical imaging experts their authorizations are outsourced to denied the procedures, sent the declined letters to me, then a few hours later re-reviewed the request and approved them. They're saying I'll probably get the approval letters in the mail today.

Insurance. What a cluster.

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CowbellMaster said:   I called the office today and was told they verified the authorization was approved before scheduling the procedure. Hmmmm

So then I called my insurance company and was told authorization was, in fact, approved! Hmmmmmmmmm

Faxed them the authorization declined letters. Turns out the medical imaging experts their authorizations are outsourced to denied the procedures, sent the declined letters to me, then a few hours later re-reviewed the request and approved them. They're saying I'll probably get the approval letters in the mail today.

Insurance. What a cluster.

  
Always is. Insurance will always try to find a way to not pay. 

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So, do you have little-green-man in your brain or not?

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ZenNUTS said:   So, do you have little-green-man in your brain or not?
It's not a tumor!

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jerosen said:   Did you ask the neurologist to get preauthorization from your insurance before hand?
edited out.

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CowbellMaster said:   I called the office today and was told they verified the authorization was approved before scheduling the procedure. Hmmmm

So then I called my insurance company and was told authorization was, in fact, approved! Hmmmmmmmmm

Faxed them the authorization declined letters. Turns out the medical imaging experts their authorizations are outsourced to denied the procedures, sent the declined letters to me, then a few hours later re-reviewed the request and approved them. They're saying I'll probably get the approval letters in the mail today.

Insurance. What a cluster.

Based on my experience (including several recent procedures) this is usually how it works. It's almost like they automatically deny it the first time, and then your doctor's office sends them more info, then they approve it. Of course, in the meantime, they automatically send out a denial letter based on the original "review", just to get you worked up over nothing. Here's a fun recent example: insurance sent an approval letter for cervical spinal fusion hardware, then a couple of days later sent a denial letter for the surgery to implant that very same hardware. 

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Few things in life are worse than hiring an insurance company to ration your health care.
Off the top of my head, empowering government to ration your health care is the only one I can think of.

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