Saturday, April 20, 2013

My MRI Drama

Ever since my husband switched jobs about 1 1/2 years ago, our health insurance changed from United healthcare to Oxford. If you recall, I had major issues w UHC back in 2010 when they denied my surgery. After an appeal the denial was overturned but I later had more issues with my out of network benefits. Oxford is owned by UHC but operates under its own rules. One of those rules is that under my particular policy, I require pre-certification for every MRI, CT, surgery, injection and god knows what else. Generally the scans are approved within a day or 2. This time things were not quite as simple. Oxford outsources their radiology pre-certification to a company called Care Core. Care Core is supposed to approve or deny the procedure within 2 days. My CT (which is a less expensive scan) was approved right away. The MRI was not. Care Core needed more info- specifically "was my hip pain treated w 4 weeks of NSAIDs" as it "typically" should. Well, this got me a bit riled up....I mean- how many Naprosyn's does Care Core think will make me walk? And to be honest, I wouldn't call this "typical". So, my doctor's office had to send more info and explain that I had already done more than 4 weeks w an NSAID cream.... And the MRI was denied. So I became a little more agitated....and why didn't they have he same requirement for the CT? I mean- if I have to be on 4 weeks of NSAIDs then lets adhere to the same rules all across the board... Not just for expensive scans. In the end, the MRI was approved, 10 days after the initial request. Once it was approved, a lovely representative from Care Core called me to let me know. (It is important to note that she was lovely bc everyone I spoke to was lovely. It is the game that medical management companies play- its much harder to yell and scream at someone who is sweet as pie) "My MRI is approved to be done at XYZ facility in the Bronx". Huh? The Bronx? Wtf? I calmly explained to her that I will not be having my MRI in the Bronx but at the same hospital where I have had all (I forget the number) previous ones. And why was this particular facility chosen?? "Bc your doctor requested it. And your Ct is approved at that facility as well". Hmmm, my doctor only allows MRIs at 2 facilities and I am pretty sure neither is in the Bronx. And when I received the call about the CT, I was told it had been approved at my regular CT facility. Why was it changed? I did get them to change both scans to the right facility but why the hell is Care Core trying to pull a fast one? What the hell is going in w medical management in this country??? Last time I checked I had a very pricey PPO policy and I am shocked at the lengths an insurance company would go to cut costs


Anonymous said...

Manage to get the scans done?

Pepper said...

Freaking insurance companies. Work all ur life for health ins for the runaround when u need to get something done because you r hurting. Bs. That's the football coach coming out in me sorry.

Susie said...

I completely agree with you. Makes me so mad