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realisticdreams
member
MRI Appeals Denied.
realisticdreams
member
I don't even know what to do, the entire story is in my blog but the doctor did a peer to peer review on Friday, which is what they said could maybe get it approved, but they denied that as well. The nurse basically said to call the neurosurgeon back when she gets worse.
Tethered cord damage is irreversible, and she is worse. She's falling down more than she's up & she's on her tippy toes 50% more than she used to be, her urinary incontinence/retention is a weekly thing, etc, etc, etc. The hospital said I wouldn't be eligible for charity care or financial aid & have to pay the insurance company directly. She meets the imaging associate criteria for having MRI's done so I don't know how the insurance can do this.
The medical director in Richmond is playing GOD & it's not fair. I doubt the appeal I wrote up will do anything if the neurosurgeon couldn't get anywhere with them. Mother Fers.
DD1(4):VSD & PFO (Closed!), Prenatal stroke, Mild CP, Delayed pyloric opening/reflux, Brachycephaly & Plagiocephaly, Sacral lipoma, Tethered spinal cord, Compound heterozygous MTHFR, Neurogenic bladder, Urinary retention & dyssynergia, incomplete emptying, enlarged Bladder with Poor Muscle Tone, EDS-Type 3. Mito-Disorder has been mentioned
DD2(2.5): Late term premie due to PTL, low fluid & IUGR, Reflux, delayed visual maturation, compound heteroygous MTHFR, PFAPA, Bilateral kidney reflux, Transient hypogammaglobulinemia, EDS-Type 3
http://justthetipblogg.blogspot.com, The Neglected Blog.
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Re: MRI Appeals Denied.
I have no clue. I have never been as emotionally frustrated IN MY LIFE.
But it's ok though, because the Anthem nurse just informed me that "she understands what I'm going through."
THE F YOU DO!
It's been forwarded to an outside source/corporate for review, so it's out of Anthem's Richmond's offices hands.
I'll admit I just skimmed the last two entries in your blog, but have they done an ultrasound of the tethered cord area? They were able to rule it out in my son's case and never warranted an MRI, but I know that this preliminary diagnostic has gotten a few of my friends' kids the MRIs they needed...
Sorry if it's redundant, or irrelevant. I know it's very frustrating, I've been on both sides of the argument (as a patient requesting treatment and a medical adjuster reviewing requests for treatment).
Also, I think you were the one who posted about your LO being diagnosed with MRSA lately? DS just got his diagnosis last Wednesday and we're on a 10 day course of Bactrim. OY!!
I hate this post. Hate it. I can't imagine how you must be feeling. This would push me over my emotional breaking point I think. How much would it be out of pocket? Can you just do it and make small payments over time? Like $10 a month or something?
They said I had to sign a waiver that I would pay the insurance directly. The hospital itself only allows payments if it goes to their collections agency & they must be paid within 12 months, so..$20,000/12 is not something we can do. I faxed over a family/member appeal, but I'm not sure if that's going to get anywhere. I just don't understand. You have the freaking American Imaging BS thin to go by. It says, conditions X, Y Z are covered. If the person has X, Y, or Z then it shouldn't even go to a dr for review. The nurse should just approve it, you can't use the guidelines to your advantage AND the patients disadvantage.
I don't think an ultrasound will help because her cord is just above the cut off point on a normal MRI but the prone view will show us if it moves or not.
https://radiology.rsna.org/content/220/1/208.full (this article explains it better than I can).
Yeah Morgan has it & is on bactroban cream & the bactrim oral. Peyton had it a few months ago as well, except they lanced & drained hers (horrible).
I don't know where/why they both have gotten it! The pedi said someone in the house might be a carrier...Dh got it from Morgan & had cellulitis as well. I'm the only one whose never got it, so maybe i'm the carrier? I'm not sure.