Question about MRI's and insurance...
 

Hello everyone:)
I am new here. I had posted a week or so ago. I am still waiting to get my MRI's. I am having a problem with my insurance approving the contrast of my MRI of the Brain study.

I was approved for C and T spine MRI's without contrast, however, for some reason they are not approving me to get the contrast with the Brain MRI?!! It si very frustrating:(! I have waited so long to get to this day (was supposed to have the Brain MRI tomorrow) and have had to cancel it. I now have to wait until Monday to see what the ordering Doctor (my Neuro) wants to do. Fight it or just get the Brain MRI without contrast. I do have my first MRI of the C & T spine Saturday (without contrast).

My question is, has anyone else had any issues with getting a contrast MRI? I thought I had a pretty descent insurance plan (Horizon NJ Blue cross Blue Shield), but have learned they seem to fight allowing the contrast part?? WOnder why? Is it because of the added cost? Are there major differences with the MRI if I can only get it without contrast (Brain)??

Thank you for your time and help!:)

It is because they are basically doing 2 scans (and charging accordingly). One scan before the contrast, and then a second after the contrast. Generally, if nothing shows up on the 1st scan, nothing will show up on the post-contrast scan. The insurance company sees it as excessive to do the contrast scan until they know for sure there is something to look at. Lawyers have started working hard to go after places doing scans with contrast due to the impact the contrast can have on your kidneys. On that basis, I am sure the insurance companies see it as in their own best interest to limit how many people get MRIs with contrast that may not be needed.

Sure it is more expensive down the road if you have to go back and get both scans at a later date and it is inconvenient for you, but it is something the insurance companies can use to limit how many people get exposed to contrast (and any subsequent litigation that may erupt down the road). It is just one more way that allowing lawyers to run rampant with medical lawsuits is raising our costs and making good care harder to get.

Thank you for your reply! I never thought about the contrast and its effect on the body...now I'm not so worried if I don't get it.

I know there are pros and cons. It's just frustrating to wait to even get the MRI order, schedule it, wait another couple weeks to only have to cancel it!!! Sorry for the rant..lol

That's interesting how they do the MRI's in the USA. So far, my experience in Canada is that I have the MRI's without contrast, the radiologist has a quick look at the result, then if something (new) has shown up in a specific area, they put in the contrast and do the second ones right then. Hmmm.....

As far as I know, the contrast is to determine if the new lesions are active or not.

With love, Erika

I guess I am fortunate in that my neuro doesn't order MRIs very often unless some big change occurs. He does order contrast, but based on the recent findings about effects on the body I'm going to ask that he not unless necessary, as Erika stated above.

when i was dx'd 11 yrs ago i had mine with contrast and wasn't questioned.
that's what the dr ordered and that's what was done.

medically it may partially depend on your sx's and presentation. i would think if you're a new pt, early in the dx or very symptomatic that you might benefit from contrast. it can help the dr "see" more active disease (lesions). i would let your neuro decide and have them go to bat for you.

i fear that in today's world insurance comp's will try to penny pinch medical costs and micro manage to save $$$. i wish they'd leave medical decisions to the dr/pt. just imho.

I agree Judy! The Doctor wrote for contrast so the fact that they question him is frustrating!

Tomorrow is my first C and T spine mri. A little nervous. Does anyone know if I get the CD after the test, would I be able to view it on my computer?

Well, it looks like they ordered me the MRI without contrast. Guess my Doctor changed his mind or gave up arguing with the insurance?!

I always get with and without contrast . . . and on a T-3 machine or better. Lesions do not show up on weaker machines, but I know many have had them and been diagnosed off of them.

you have a legal right to your records, from anywhere you have a test or visit.
when you go in for the mri tell them you want a copy of the cd and a copy of the report.

you may or may not need to go back to p/u the reports, or, they may have the cd ready for you when you leave. the report may take longer. make the request when you're there because you will have to sign a release.

you won't be able to tell anything yourself by looking at the cd but if you ever see another dr you'll need the copy to take with you. keep the report for your records.

start a medical file on yourself. start to get copies of the dr's dictations. one day it will come in handy. also, for myself, i've read dictations where the info was wrong. you can either call the office and have it changed or write a letter of clarification. fyi.