How long must I wait?
August 25, 2011 7:12 PM Subscribe
Is it reasonable for it to take over a week for my doctor's office to get back to me about an MRI?
[background]
I somehow hurt my arm rock climbing. I took a break for a few weeks, and when the pain didn't go away, I went to one doctor, who said it was a tricep strain and send me to physical therapy. I wasn't real sure of this diagnosis as I didn't seem to have significant weakness (i.e. I could still climb the hardest thing I had ever climbed -- it just hurt), but I decided to go with it. As soon as I started physical therapy, the pain moved into my shoulder. Still, I continued to go to physical therapy for the prescribed six weeks, with basically no reduction of pain. So I called the doctor up, and she recommended more physical therapy. I decided to get a second opinion, so I went to another doctor last Wednesday morning. He thought it was probably bursitis but maybe a muscle strain, and said that he could either give me a shot of steroids, or look at an MRI and be sure what was going on, but not both as the shot would give confusing results on the MRI. I decided to go with the MRI.
[probably the important part]
He handed me a prescription for the MRI, and said his office would take care of having it approved by my insurance (United HealthCare, don't recall what plan but I can go to any doctor including specialists without any sort of preapproval). His office said they would call me and tell me when/where I could go. I called them on Monday to confirm that I wasn't lost in the system, and they said that they had a backlog and would get to me when it was my turn. So now it's more than a week later, and no call.
[the questions]
Is it reasonable to wait more than a week on this? Is there a better way to get this MRI approved?
[background]
I somehow hurt my arm rock climbing. I took a break for a few weeks, and when the pain didn't go away, I went to one doctor, who said it was a tricep strain and send me to physical therapy. I wasn't real sure of this diagnosis as I didn't seem to have significant weakness (i.e. I could still climb the hardest thing I had ever climbed -- it just hurt), but I decided to go with it. As soon as I started physical therapy, the pain moved into my shoulder. Still, I continued to go to physical therapy for the prescribed six weeks, with basically no reduction of pain. So I called the doctor up, and she recommended more physical therapy. I decided to get a second opinion, so I went to another doctor last Wednesday morning. He thought it was probably bursitis but maybe a muscle strain, and said that he could either give me a shot of steroids, or look at an MRI and be sure what was going on, but not both as the shot would give confusing results on the MRI. I decided to go with the MRI.
[probably the important part]
He handed me a prescription for the MRI, and said his office would take care of having it approved by my insurance (United HealthCare, don't recall what plan but I can go to any doctor including specialists without any sort of preapproval). His office said they would call me and tell me when/where I could go. I called them on Monday to confirm that I wasn't lost in the system, and they said that they had a backlog and would get to me when it was my turn. So now it's more than a week later, and no call.
[the questions]
Is it reasonable to wait more than a week on this? Is there a better way to get this MRI approved?
I had an MRI that found my brain tumor, so I am familiar with MRI's and their requirements from a patient and a consumer of insurance stand point. I am not a doctor.
MRI's are extremely expensive to the insurance company, so doctor's are often hesitant to prescribe them without having a very solid medical argument for one. In the first MRI the doctor had me go to a second doctor just to be sure there was a valid medical reason (there was - a brain tumor). The second doctor's appointment to the MRI occurred within a day.
The typical process is as you have found - the doctor will request one, the staff at the doctor's office will send the request to the MRI facility (usually outpatient). It is the MRI facility which contacts the insurance company for the approval.
In some circumstances you can schedule the MRI at the facility, but often by the time you are taking the appointment they already know if insurance approval was received. Regardless the MRI facility will be waiting for your doctor's request.
A week is a bit long. My guess (only a guess) is because it is discomfort and not an immediate life threatening situation you are placed at the bottom of the pile.
To get the process moving faster - is it possible for you to find an in-network MRI facility (as I am assuming it will be outpatient) and schedule the appointment yourself? Now you will have the MRI facility (who is eager to charge the thousands of dollars to your insurance company for their services) hounding your doctor's office for the paperwork as well as handling the insurance for you.
Good Luck.
posted by BuffaloChickenWing at 7:31 PM on August 25, 2011
MRI's are extremely expensive to the insurance company, so doctor's are often hesitant to prescribe them without having a very solid medical argument for one. In the first MRI the doctor had me go to a second doctor just to be sure there was a valid medical reason (there was - a brain tumor). The second doctor's appointment to the MRI occurred within a day.
The typical process is as you have found - the doctor will request one, the staff at the doctor's office will send the request to the MRI facility (usually outpatient). It is the MRI facility which contacts the insurance company for the approval.
In some circumstances you can schedule the MRI at the facility, but often by the time you are taking the appointment they already know if insurance approval was received. Regardless the MRI facility will be waiting for your doctor's request.
A week is a bit long. My guess (only a guess) is because it is discomfort and not an immediate life threatening situation you are placed at the bottom of the pile.
To get the process moving faster - is it possible for you to find an in-network MRI facility (as I am assuming it will be outpatient) and schedule the appointment yourself? Now you will have the MRI facility (who is eager to charge the thousands of dollars to your insurance company for their services) hounding your doctor's office for the paperwork as well as handling the insurance for you.
Good Luck.
posted by BuffaloChickenWing at 7:31 PM on August 25, 2011
I guess it depends on where you are because where I work, the doctor's office gets the approval for the MRI. In fact, I've never worked with an MRI facility that gets their own authorizations (if I found one, I'd use them exclusively- it's part of my job to get insurance authorizations and they are a pain). I can tell you that unless you have some sort of Cadillac plan through United Healthcare, they do require authorizations for MRIs.
Has your doctor's office even started the process for authorization? When I request any kind of imaging, I do it online. The insurance will either send it to a medical person (nurse or doctor) to see if my request is reasonable or instantly approve it (they have a list of diagnoses that get automatic approval by the computer). If the medical person thinks the request is reasonable, they approve it. If not, they will want more information like why an x-ray won't work in this case, what other tests we've done, etc. The whole process from request to authorization can take anywhere from 24 hours to a week. If your doctor hasn't even requested it yet, they are understaffed and you might want to start looking at second opinions. You could also call your insurance company directly- you (or your employer) are paying them- they work for you, not your doctor, and it is in their best interests to keep you happy. It's unusual, but I've had patients get their own authorizations for things because their doctor dropped the ball. It's worth a shot, anyway.
posted by dogmom at 7:45 PM on August 25, 2011 [1 favorite]
Has your doctor's office even started the process for authorization? When I request any kind of imaging, I do it online. The insurance will either send it to a medical person (nurse or doctor) to see if my request is reasonable or instantly approve it (they have a list of diagnoses that get automatic approval by the computer). If the medical person thinks the request is reasonable, they approve it. If not, they will want more information like why an x-ray won't work in this case, what other tests we've done, etc. The whole process from request to authorization can take anywhere from 24 hours to a week. If your doctor hasn't even requested it yet, they are understaffed and you might want to start looking at second opinions. You could also call your insurance company directly- you (or your employer) are paying them- they work for you, not your doctor, and it is in their best interests to keep you happy. It's unusual, but I've had patients get their own authorizations for things because their doctor dropped the ball. It's worth a shot, anyway.
posted by dogmom at 7:45 PM on August 25, 2011 [1 favorite]
I had to wait weeks to get mine for my tumor in my neck. They did an ultrasound first, then biopsy, then MRI. It took a long time between each step.
posted by cjorgensen at 8:27 PM on August 25, 2011
posted by cjorgensen at 8:27 PM on August 25, 2011
When my PCP at my HMO ordered an MRI, it was approved instantly (literally - the computer handled the approval) and the clinic staff scheduled my scan for 2 days later. I didn't even have to call the MRI place, the staff in my PCP's clinic could do it for me.
Larger healthcare organizations tend to be better-organized and more integrated, so if you're bothered by these kind of organizational mishaps you might want to consider seeking care at a larger, integrated facility. YMMV - some larger organizations are really bad - so ask people who have been to the larger places in your area and choose one where people have good experiences.
posted by Tehhund at 9:09 PM on August 25, 2011
Larger healthcare organizations tend to be better-organized and more integrated, so if you're bothered by these kind of organizational mishaps you might want to consider seeking care at a larger, integrated facility. YMMV - some larger organizations are really bad - so ask people who have been to the larger places in your area and choose one where people have good experiences.
posted by Tehhund at 9:09 PM on August 25, 2011
A week doesn't sound like a very long time to get approved for an extremely expensive test over something that sounds like it's more an annoyance than an urgent medical issue. It's probably warranted to do the study given the length of time you've had the pain, but it doesn't sound like there's any urgency to getting it done.
posted by treehorn+bunny at 9:15 PM on August 25, 2011
posted by treehorn+bunny at 9:15 PM on August 25, 2011
Yup - it's always taken that long for me. It sucks.
posted by guster4lovers at 10:06 PM on August 25, 2011
posted by guster4lovers at 10:06 PM on August 25, 2011
Check what the reimbursement rate for non-pre-authorized procedures is. I had a CT scan a while ago and totally didn't bother getting authorization, my insurance covered a big chunk of it anyway.
posted by trevyn at 11:52 PM on August 25, 2011
posted by trevyn at 11:52 PM on August 25, 2011
Response by poster: Update: I called UHC, and they said that on my plan, they don't need to authorize anything, but that my doctor would be sanctioned if he didn't put in a "notification." Well, I don't much care if this doctor gets in trouble, so I went ahead and scheduled an appointment. I did call the doctor's office to give them a heads up. They told me to call back in an hour or two to talk to a specific person. When I called back, he had left for the day. Then they said that I didn't need anything from them. Awesome.
posted by novalis_dt at 10:31 AM on August 26, 2011
posted by novalis_dt at 10:31 AM on August 26, 2011
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You can find another Dr. with a smaller practice who might follow through quicker..... There are pros and cons on either side of this coin...
That said... the "my turn" comment would cause me to tell them to take a hike...
posted by tomswift at 7:30 PM on August 25, 2011 [2 favorites]