Does anyone know how to get an MRI w/o a referral?

hey anne i hear your frustration but MRI's are so expensive often if the doc refers you and the insurance still denys. recently my mom was denied because she had a mri of her right knee and it showed the need for surgery~ she declined then when her left knee acted up the doc declined the mri stating the only reason to take it would be to solve it and if she still doesnt want a surgery, no mri. with that said, maybe the reason is not to take your mri because the information at this could not benift any difference in proceedures? i am guessing it is your rhuemmy who is denying you? or pcp? if you feel a stron conviction about this i suggest you get a second opinion. i do wish you much luck. take care yally

Hi guys, thanks for the answers and kind responses. I was thinking about just getting a second opinion. I just want to know exactly where all the damage is and to what extent. We are getting into some discussion of more serious treatment and while I know where my pain is and where I swell, I want to know exactly how much damage is already done where so I can make smart choices, you know? And I guess no one lets you just get an MRI on your own, the world is controlled by doctors and referalls. You know, they say well a layperson would not know what to order. Well, that is not always the case; it depends on your background and who you know. Anyway, I am just venting. Thanks so much for your help!

Hi Raven,

Not so close to Montreal but you never know when I might travel, I'd gladly take the info anyway, thank you so much! I am yes, in the States, Colorado actually, and was looking for something just like that. I figured there would be a clinic here but it is not so I believe. Our healthcare could improve for certain.

Thanks Again!

Hey Upwords,

After reading ur forum, i may be able to help you...in regards to the Mri Refferal...I work at a hospital and I verify health insurance for patients so im quite knowledgeable when it comes to Health insurance...

First question is What is the Name of you health insurance?

Now beucase you said that u needed a Refferal to get a Mri, im questioning that beucase usually if you health insurance requires a Refferal for your plan, im assumming that your health insurance will most likely need an Authorization to get an MRI, Believe it or not, I have dealt with Many Doctors who in fact are quite lazy when it comes to getting an Authorization for there patients, thats why most times a Doctor's first and second response would be, "ahhh you dont need an MRI, beucase im treating you for the Disease"

That doesnt sit well with me,  nor should it sit well with you, between you and Me an Xray is absolutely useless unless you broke a bone!! -

An Xray will never reveal Inflammation, nerve dammage or tendon damage, So you either need to switch doctors, or be really insistent on your doctor to get an authorization...

Also---getting an authorization is not a big deal, especially if u already had an xray, and the Patient which is you, is still experiencing Pain and suffering...***All the doctors office has to do is give the Clinical, and if done correctly, you can have an authorization from your health insurance plan within 72hrs....

The patients that come into the facility that i work in, come from all over, even out of state, patients as well as foreigners from different countries come in for testing...Soo whether you insurance is Medicaid, Medicaid HMO, Medicare, Medicare Hmo, or a commerical insurance such as but not limited to-HMO's,PPO's, EPO's, as long as the proper clinical is submitted, it doesnt matter what the insurance is, u should be able to get that MRI or CT Scan...

Also there are times, that certain insurance plans require that you may or may not have an "OUP=out of Pocket" or a "DED=deductible" if that is the case I can break that down to you too...So let me know what your insurance is, and I will try to help you utilize your Health insurance plan to the fullest benifit, its quite unfornate at times, that most of us lucky individuals have insurance, but sometimes we dont understand how to utulize it to the fullest..

And the stupid doctor's dont help neither, especially if their Receptionist doesnt know how to get an Authorization or Refferal for us Patients..

I always feel that if you the Patient feels that you should get an MRI, to further evaluate the disease in more detail, then by all means, its you're given right, remember You the patient are dealing with this disease, and you the patient want the best possible treatment, what if you get an MRI, and it reveals something other than what your Doctor is treating you for..Its us the Patient that is suffering-Not the Doctor...

I hope i didnt scare u or anything, im just concerned that your doctor has not been Proactive enough to do the proper thing and send you in for an MRI..

I hope you are doing better, and have many more better days to come, and let us know how you are doing.

BabZ

hey upwords,

ok to answer your question, inregards to getting an authorization, usually u can obtain an authorization through your PCP=Primary care Physician also known as ur Primary Doctor..This is becuase ur primary doctor would have all you Medical history & clinical..

Basically all an authorization really means is this: its stating that its medically nessecary to get a certain test, and by getting an authorization, its when an insurance company says, ok the patient needs the test, and the patient can be approved for this test, whether it be a CT scan or MRI or any other test that can be costly..

Alot of times certain test are quite costly, so therefore they may be some restrictions on what we can and cant get at the time of service.

unfornately a Patient cant get an authorization beucase it must be

requested by the doctor themselves or the ordering doctors office can obtain it, usually they can call the insurance company, and there are times, when they fax ur medical info onto the insurance company, and then the insurance reviews ur case, and approves the test accordinally..

Im not familar with your particular health insurance, however if u want me to verify it for u can email me at [email protected], however if u dont feel comfortable with that, my advice to you, and I tell all the patients that I deal with, is to simply look on the back of the card, and they should be a toll free number on it saying Providers/members and also a number for "Prior Authorizations"...If I was you, I would call the insurance company...and try to call the authorization line, and speak to one of the representatives---and ask them what is the requirments for getting an MRI, and ask the representative if you need an authorization or a refferal...Get the persons Name & last intial of who you spoke too...Then forward the information onto the drs office...

and to be on top of ur game, if ur drs office says that they are in the process of getting ur authorization, u can always double check with your insurance to see whether or not, ur doctor called one in...

Alot of times, ive had doctors tell me and my patients, "ahh yes i called it in and its pending, and then when i call to see if thats the truth, half the time the doctor didnt even make that call....

Also dont be intimidated the ur Health insurance, beucase its there job to help u understand ur health benifets, and if it wasnt for u and ur husband, those Reps at the insurance company wouldnt have a JOb...Also call Members services which should be on the back of the card too, they too can help u understand what u are covered for and what you arent covered for...

The only thing that the insurance company will and should ask you is this...

Your Name

Your DOB

YOur insurance Policy ID#, which is found on the front of the card...

and then u take it from there...I hope this helps...

Please feel free to ask me what ever questions you may have....Im glad to help you in any way...

Again I hope u feel better...

BabZ