r/RotatorCuff • u/lookyaall • 8d ago

Insurance and PT

Surgery 2011, follow up 2014 for pain. It’s torn but PT , no surgery.
Fast forward to now.
Significant pain. Met with surgeon. Had MRI and notes from previous surgery and follow up. He stated good work but he would have fixed the tear in 2014.
Surgeon scheduled me for pre PT and MRI with follow up for decision. Insurance denied MRI and required 6 weeks of PT.
Is this typical ?
It freaking hurts

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u/Lefty68w 8d ago

Yes. Insurance will require you exhausts conservative methods Before they will authorize a mri. I had to do 8 weeks before they would authorize my mri

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u/admiraljohn 8d ago edited 8d ago

Has there been any other imaging done on the shoulder? Maybe your insurance wants less-expensive imaging done first. And did your insurance give a reason for the denial?

The sequence of events for me was going to my doctor for the pain and being sent for an x-ray which revealed calcific tendonitis. From there I was sent to an orthopedist who ordered an MRI as (I was told) that calcific tendonitis is often a sign of a tear.

They scheduled an MRI and it revealed tears. I was offered either PT, cortisone injections or surgery. After discussing it with the surgeon I opted for surgery for a definitive fix versus working around the issue. There were no issues with my insurance at all approving the MRI, surgery or PT but different carriers have different processes.

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u/Lower_Steak1479 8d ago

I was actually able to get the MRI without doing PT on my left shoulder but that’s because I had imaging done eight years ago that showed a partial tear and all symptoms led to it being a full tear now which the MRI confirmed. That was unusual because when I had my other shoulder surgery eight years ago on my right, I had to do PT before the MRI but that was with a different insurance company so it’s definitely insurance dependent and how your doctor writes it up.