Insurance companies and their little tricks....

What a mess Brett! I hope the next doc has their stuff together.

 

sorry about your knee i have a bad knee so bad i have been forced to retire it has been 3 years sense it happened and it is just finally getting settled do not let anyone bully you just do what is best for your knee

 

Brett, my insurance company told the dr to put me on anti-inflammatories and physical therapy for a year and a half before they approved the MRI on my shoulder. By the time they finally approved it, I couldn't use that arm at all. What could have been a minor surgery ended up being a major reconstruction. Never got full use back and ended up costing the insurance co. about 20X more. Stay on the insurance company, or maybe have your doctor refer you to an orthopedic specialist and have them request the MRI.

 

I honestly didn't know this stuff happened out there? I guess I'm blessed to still be on my parents play that has not turned my 6 member family down for anything ever. Kinda mind blowing to me!

 

Most of the stories about insurance companies being difficult are just like this one started. A total misunderstanding of where the breakdown in communication was. I have sold insurance, including group medical for 23 years and can tell you that they are not in the business for the purpose of denying claims. I will never defend everything these companies do, but can tell you that they quite often take the blame for things that are not their doing. This case is a prime example. Most health insurance companies are very reputable and helpful. It is a free market, they would not stay in business if they did not take care of their members.

 

Wow...why would your doctor jerk you around like that? Good luck with your recovery Brett....I've had my share of major injuries so I know what your going through

 

I hear you. Went in and got a cortisone shot yesterday. I also have to do three weeks of physical therapy. If those two things don't resolve my issues, I guess the insurance company is bound by it's policy to allow me to get an mri. I wish they would have see the big picture and just allowed me to get it asap based on many factors. Oh well.

 

I hope the issue with your knee gets resolved quickly. Nothing is worse than feeling bad, either from sickness or injury.

It does sound like more of a Doctor problem. My son had a minor snowboarding injury this past season involving his foot. His Doctor ordered an MRI upon initial examination and the insurance company (Blue Cross) never balked or blinked an eye.

 

Many clinics and hospitals are too quick to use very expensive equipment as a way to boost revenue. Due to lowering reimbursements by medicare and medicaid they have to create revenue in other areas. Unfortunately, too many times that means running tests and procedures that may not be necessary. The insurance companies are merely trying to pull in the reins a bit because you and I dont want to continue paying double digit rate increases. It's a fine line. The insurance companies are damned if they do and damned if they dont. We want preferred medical treatment, but we dont want to pay the premiums required to support the system that provides it. It's circular and not likely to change soon.

 

In this case, the right call was to get the mri from the get go, insurance protocol or not. But I don't control them so I must abide by their rules.

 

Maybe so. But statistically, it saves them money which means it saves you money. Figuring out what is most efficient is not an exact science. Either is medicine. I have a great friend that is a doctor and he will admit that many times they are merely making educated guesses. They throw something at the wall and see if it sticks. If not, they go a different direction. The insurance companies are not making these decisions without having medical professionals help them establish protocal. There is not some guy sitting at a big desk and zero understanding of medicine making any of these decisions. They come from groups of medical professionals making recommendations for procedure to the insurance companies.