Template for coverage of 3T MRI

[carolynm]

Hello friends,

Has anyone had to write a letter to insurance to justify need for this? I have already had a pelvic MRI done recently so they are questioning why I need another one.

Thanks in advance,
cari

[donstore]

Cari,
It is hard to get insurance to pay for more than one MRI per year unless your condition has changed due to some trauma or if a doctor says that the 3T MRI is necessary to better visualize your pudendal nerve. Even Dr. Hibner accepts the 1.5T from his local radiologist, Dr. Kalinkin although he does specify that her or Dr. Potter are the two choices to help him diagnose. We know Dr. Potter is the one to see due to her expertise and special software but what we think doesn't matter. If I were you, I might think about inventing a traumatic and dramatic injury that would justify a new MRI. You would need to tell your doctor that you slipped on some stairs and fell back directly on your tailbone and experienced heightened pain directly after and it has been worse ever since. He could then include this in your official clinical history and it would documented. You have to give the doctor something to hang his hat on when making the appeal. Assuming you have already told them about the pickaxe which we all understand but not quite as dramatic even though it's the truth and besides you have already told them about that. I can't imagine what negative impact this would have on your treatment plan. It's all about getting them to pay. Just a thought. Good luck.

Don

[carolynm]

Thank you, Don. I have a feeling this is going to be out of pocket. Ugh.

cari