Andres Update – Another MRI

Today did not turn out like I had expected.  I was expecting tonight to be breathing a sigh of relief knowing that because of Andres’ Chiari malformation, we had gotten a full MRI of his entire spine.

I was not expecting a call this morning from the doctor’s office saying the full spine MRI had been denied by the insurance company with the explanation that they’d only be willing to do that if we were concerned about cancer (which I know is not the case, seeing as my daughter had a full spine MRI due to scoliosis).  They were willing to do the MRI of the C-spine (the neck part of the spine) which the neurologist had suggested, so we did go ahead and get that done.  Interestingly, though, I called the insurance company to give them a piece of my mind, and they were incredulous, saying, “We have no record of this, we haven’t talked to any doctor’s office about this.”   They offered to get the doctor’s office on the phone, which they did, and come to find out it was not the insurance company who denied it, it was a third party hired by the MRI company to screen MRI orders, and they had the power to decline my doctor’s order for an MRI.

Is this not ridiculous?  So a third party, who is probably not even a nurse, much less a doctor, decided he knew better than my son’s doctor about what imaging would be a good idea for my son.  And he has the power to make that decision?  It’s nuts.

The insurance company said my doctor can send a letter of medical necessity and then the insurance company can override the MRI place.  (Which my doctor says he is willing to do, but he does agree the medical necessity of it is a bit in the gray area and was only requesting the full spine MRI since we were going to be down there anyway and there is the possibility something could show up further down the spine.)

So the plan for now is to wait on the results of the MRI from today, go to the neurologist with that information, and find out his opinion on the next step.

You know, the times that you need insurance the most are the times you are least prepared to deal with all the problems.

On an up note, the MRI went well; Andres was a trooper even though this time it was with and without contrast which required an IV.  Now we wait.  I’ll know something by the end of the week.

Please keep praying for total healing for Andres and for wisdom, compassion and a genuine interest in Andres from the neurologist in Austin.  Our prayers have been answered to that extent from the neurologist in Houston.

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3 thoughts on “Andres Update – Another MRI”

  1. With the costs of medical care and tests going sky high, the pinch is probably on different providers to make sure of things like this. Yeah, I’d be way annoyed that someone not a medical practitioner decided whether my son needed an MRI. Hang in there…xxoo

  2. I’m so sorry to hear the trouble about the insurance, well, actually the third party… It’s the same everywhere, isn’t it.

    Be sure that there will be a flood of prayers sent for total healing for Andres!

    Thank you, for keeping us – your readers – updated on the situation. It is always great – and so much needed in this world – to read real testimonies of real people with real problems who still receive real miracles from a very real God. 😉

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