Moronic Insurance

[Adalaide]

After three months gluten free. I'm still having some pretty serious neurological problems. My biggest complain is severe migrating pain. My doctor wants me to see a neurologist, makes sense to me. We just want to rule out MS before we send me off to the rheumatologist to diagnose or rule out lupus. (oh joy) I have no doubt it'll come to a diagnosis given my come and go butterfly rash. It was the first suspect when my symptoms became troublesome four years ago.

Anway... so I finally get a call back from my (crap) insurance today about the referral. She's like "what's the diagnosis?" So I told her what the doctor told me, the point of the visit is for undiagnosed symptoms. "Yeah, but what's the diagnosis?" So I explained that the point of the visit is to obtain a diagnosis. (duh!) "Great, so have the doctor fax over the referral and clinical notes so we can decide what testing you need done before you see the specialist." Wait... so now medical insurance companies with pencil pushing pinheads whose entire medical background is coding and screwing over patients are making decisions about what type of medical care and tests I need? Is it just me or is this highly abnormal? I mean, I'm going go do whatever but shouldn't a doctor be ordering these tests? Especially since if we're talking MRI he needs to specify what we're looking for and if we're talking LP the odds of getting me to let someone stick a needle the size of Texas in my spine are pretty close to zero unless an actual medical doctor tells me it's necessary.

[Bubba's Mom]

After three months gluten free. I'm still having some pretty serious neurological problems. My biggest complain is severe migrating pain. My doctor wants me to see a neurologist, makes sense to me. We just want to rule out MS before we send me off to the rheumatologist to diagnose or rule out lupus. (oh joy) I have no doubt it'll come to a diagnosis given my come and go butterfly rash. It was the first suspect when my symptoms became troublesome four years ago.

Anway... so I finally get a call back from my (crap) insurance today about the referral. She's like "what's the diagnosis?" So I told her what the doctor told me, the point of the visit is for undiagnosed symptoms. "Yeah, but what's the diagnosis?" So I explained that the point of the visit is to obtain a diagnosis. (duh!) "Great, so have the doctor fax over the referral and clinical notes so we can decide what testing you need done before you see the specialist." Wait... so now medical insurance companies with pencil pushing pinheads whose entire medical background is coding and screwing over patients are making decisions about what type of medical care and tests I need? Is it just me or is this highly abnormal? I mean, I'm going go do whatever but shouldn't a doctor be ordering these tests? Especially since if we're talking MRI he needs to specify what we're looking for and if we're talking LP the odds of getting me to let someone stick a needle the size of Texas in my spine are pretty close to zero unless an actual medical doctor tells me it's necessary.

It's my understanding that Dr.s are supposed to give a reason for asking for a particular test? It helps eliminate the over prescribing of some tests. Usually, the Dr.s office handles that and we aren't aware it's even going on. I'm surprised the insurance contacted you instead of his office.

[kareng]

Usually, a nurse reviews this stuff & sometimes its referred to a doctor at the insurance company. Let them deal with your doctor's office. They can give them a list of symptoms and a "rule out MS" type diagnosis and ask for an approval of an MRI or whatever else they think you need. Doctor's offices do this all the time so they should be able to handle it.

Usually it is the patients responsibility to make sure the "approval" is in place before doing an elective procedure like a scheduled MRI. This means you have something from the insurance company saying you are approved or you call the facility doing the test and make sure they have an official approval from your insurance before the procedure. Hospitals want that approval because they know that getting you to pay $2500 isn't likely to happen. It is not your responsibility to explain your specific medical needs to the insurance company.