Tore an achilles tendon.
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Tore an achilles tendon.
Needed an MRI to determine the location and extent of the tear.Aetna: Denied. You didn't do an xray first.
Doctor: Tendons don't show up on xrays.
Physical Therapist: Tendons don't show up on xrays.Aetna: You didn't do an xray first.
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Tore an achilles tendon.
Needed an MRI to determine the location and extent of the tear.Aetna: Denied. You didn't do an xray first.
Doctor: Tendons don't show up on xrays.
Physical Therapist: Tendons don't show up on xrays.Aetna: You didn't do an xray first.
I tore my rotator cuff and was told by my ins that i had to have an X-ray first. Of course the tear did not show up and the ins was still saying no need for any scan. My Dr's office called them and was advocating for me, but the scan was denied until ins was told that I couldn't even pull up my own pants! Suddenly the scan was allowed and the tear was found.
Maybe you need someone to inform them of a real-life consequence, like maybe it caused you to trip and hit your head?
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I tore my rotator cuff and was told by my ins that i had to have an X-ray first. Of course the tear did not show up and the ins was still saying no need for any scan. My Dr's office called them and was advocating for me, but the scan was denied until ins was told that I couldn't even pull up my own pants! Suddenly the scan was allowed and the tear was found.
Maybe you need someone to inform them of a real-life consequence, like maybe it caused you to trip and hit your head?
We did the xray, which showed nothing, then the MRI was approved.
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I tore my rotator cuff and was told by my ins that i had to have an X-ray first. Of course the tear did not show up and the ins was still saying no need for any scan. My Dr's office called them and was advocating for me, but the scan was denied until ins was told that I couldn't even pull up my own pants! Suddenly the scan was allowed and the tear was found.
Maybe you need someone to inform them of a real-life consequence, like maybe it caused you to trip and hit your head?
Your ins? Internal doctors?
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Tore an achilles tendon.
Needed an MRI to determine the location and extent of the tear.Aetna: Denied. You didn't do an xray first.
Doctor: Tendons don't show up on xrays.
Physical Therapist: Tendons don't show up on xrays.Aetna: You didn't do an xray first.
I had a labral tear in my right hip, and I needed an MRI with contrast to diagnose it. Aetna wouldn't cover the MRI until I'd done 6 weeks of physical therapy. I ended up paying out of pocket for the physical therapy because it was an $80/session co-pay vs their self-pay rate of $70/session. Then once I'd finished therapy there was about 6 weeks of waiting until I could get in for the MRI, because Aetna wouldn't let me get an MRI at the local hospital, I had to go to an outpatient imaging center and they were booked up. And when I got the results - what do you know, near complete detachment! Something that physical therapy would never help with. After that, I consulted with a surgeon (6 week wait), and his waitlist for surgery was 4 months. (Granted, I went to one of the top surgeons in my area - I was OK with waiting for that.) So it ended up being 10 months from noticing the hip pain in May 2023 to finally getting the surgery in March 2024, and a lot of that delay was because Aetna was being obstructive.
I suspect they want people to get fed up with the roadblocks and just give up on pursuing medical care.
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Tore an achilles tendon.
Needed an MRI to determine the location and extent of the tear.Aetna: Denied. You didn't do an xray first.
Doctor: Tendons don't show up on xrays.
Physical Therapist: Tendons don't show up on xrays.Aetna: You didn't do an xray first.
So, I don’t have a lot of background on this, but supposedly some doctors have engineered approvals by asking the insurance company from a signed statement by a doctor on the refusal letter.
It’s a legal thing to request so that the clinician can avoid malpractice suits, when asked by lawyers why they waited to conduct an MRI.
Then, when the insurance company searches their staff for a doctor that will sign such a statement, they may quickly realize none of the doctors on their staff want to risk being sued for malpractice by signing such idiocy.
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Your ins? Internal doctors?
Insurance!
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We did the xray, which showed nothing, then the MRI was approved.
They are still amazed not to have found a person whose tendons will show on an X-ray… yet
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Tore an achilles tendon.
Needed an MRI to determine the location and extent of the tear.Aetna: Denied. You didn't do an xray first.
Doctor: Tendons don't show up on xrays.
Physical Therapist: Tendons don't show up on xrays.Aetna: You didn't do an xray first.
In my experience, the Norwegian public health scheme has its share of drawbacks. But they have never been shy to order an MRI. I’ve lived here 5 years now and I’ve had 4… one of them just as a “might as well, it’s been a year since surgery” status update. And they all cost me about $25 each.
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I had a labral tear in my right hip, and I needed an MRI with contrast to diagnose it. Aetna wouldn't cover the MRI until I'd done 6 weeks of physical therapy. I ended up paying out of pocket for the physical therapy because it was an $80/session co-pay vs their self-pay rate of $70/session. Then once I'd finished therapy there was about 6 weeks of waiting until I could get in for the MRI, because Aetna wouldn't let me get an MRI at the local hospital, I had to go to an outpatient imaging center and they were booked up. And when I got the results - what do you know, near complete detachment! Something that physical therapy would never help with. After that, I consulted with a surgeon (6 week wait), and his waitlist for surgery was 4 months. (Granted, I went to one of the top surgeons in my area - I was OK with waiting for that.) So it ended up being 10 months from noticing the hip pain in May 2023 to finally getting the surgery in March 2024, and a lot of that delay was because Aetna was being obstructive.
I suspect they want people to get fed up with the roadblocks and just give up on pursuing medical care.
In my case, Physical Therapy needed the MRI to confirm the nature and extent of the damage before they would even touch me. The 1 month delay caused by Aetna made everything worse.
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So, I don’t have a lot of background on this, but supposedly some doctors have engineered approvals by asking the insurance company from a signed statement by a doctor on the refusal letter.
It’s a legal thing to request so that the clinician can avoid malpractice suits, when asked by lawyers why they waited to conduct an MRI.
Then, when the insurance company searches their staff for a doctor that will sign such a statement, they may quickly realize none of the doctors on their staff want to risk being sued for malpractice by signing such idiocy.
Aetna gets around that by outsourcing the denials:
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In my case, Physical Therapy needed the MRI to confirm the nature and extent of the damage before they would even touch me. The 1 month delay caused by Aetna made everything worse.
How frustrating!!
