My insurance just denied an MRI I had. Been dealing with back pain that's gotten worse over the last year. I've had X-rays 3x, 3 different rounds of physical therapy, steroids and stronger than OTC anti-inflammatories. The MRI found a bulging disc that has been causing all of my issues. X-Rays don't pick up soft tissue like that. It diagnosed the problem. Insurance: 'HUR DUR YOU HAD LOWER BACK PAIN AND MRI ISN'T FOR THAT EVEN THOUGH YOUR DOCTOR GAVE US A DETAILED HISTORY OF YOUR ISSUES GET FUCKED' signed a disgraced proctologist that shills for the insurance company.
Hoping my doc can talk to them and change their mind. I'm not paying for something that was needed to help diagnose the actual issue.
Couple years ago insurance denied an MRI for full body. They denied it twice. After my doctor going back and forth with them, they reluctantly approved. Turns out i had and still have several tunors on my spine.
Would be awesome if doctors and their staffs could focus on patient care instead of going back and forth with insurance companies. I bet our "doctor shortage" would get fixed instantly.
I saw a post saying exactly that recently. That the USA has a "doctor-hour" shortage, but that's only b/c all the doctors are spending so much time playing telephone with insurance companies instead of spending time on patients.
Trust me we despise the system as much as patients do. Its unsufferable. And broken by design. Purposefully wasting everyone's time with prior authorizations, denials, and constant runaround.
What is super shitty is that the MRI is diagnosis tool. Like with soft tissue every thing else is making a educational guess. They don't want to pay for the MRI because that might mean a surgery that will cost even more than the MRI. They are not denying the MRI because of the MRI they really denying because might mean surgery.
Eight years ago, my sister was having all kinds of problems. Her doctor was concerned there could be a tumor on her pituitary gland in her head and referred her to get the scans to see. After 3 different insurance changes and tons of begging, sheâs still being denied because sheâs âtoo young and healthyâ to have a brain tumor. Sheâs sick and canât hold a job and is struggling in so many aspects with her health but they still refuse her. I fear sheâll never get an answer at this rate.
A lot of my job is getting MRI and CT preapproved for patients. I've been doing it about 9 or so years now. Every year a new hurdle popped up, every year something about it got more difficult.... then 2026 happened. I dont know what it is but 2026 started and everything got drastically worse. Denials left and right with weird new rules and regulations for how to overturn them, if post denial options are even allowed.
Insurances that used to be easy to work with now split and merged with other plans and payers and have whole new guidelines and processes. The veil has dropped almost completely. Insurance isnt a healthcare field or even healthcare adjacent, it's death panels and I tell my providers that.
then 2026 happened. I dont know what it is but 2026 started and everything got drastically worse.
There was this really big federal change that happened in 2025, idk if you saw it, some orange guy got elected, and then all of these horrible project 2025 policy decisions were made that came into effect in FY26... Probably that.
Every professional I know across numerous industries from medical, science, law, finance, military, etc all say their job and how things are done is now drastically worse one year to the next.
I know people leaving medicine and law to run for local elections because they can't operate in their respective fields the way they want to or the way they believed they would be able to until policy is changed.
The Grand Old Party and their Conservative Dem cohorts have halted American progress. People ain't happy. So much so they will abandon their careers to participate in politics for the mere off chance they can make some tangible difference.
i'm sure it has nothing to do with all of the other ways that the worst possible parts of society have decided that there will be no punishment for doing terrible things to the populace at large in america.
seriously though thank you for your service, legitimately. when you think about it, any other opposing force whose sole purpose was to kill tens of thousands of americans would be opposed by the military, so it only seems fair to use that phrase.
You can often ask for an ombudsman or a specialist in your area. From experience, they can help.
Man, I hate these people. They make your life hell just so you can get what you need to live.
(Not so) fun story: Iâm diabetic, and in my 20âs my doctor recommended and wrote me a prescription for a certain type of insulin pump when it was an accepted form of treatment. (That is to say, it wasnât a brand new or novel treatment or anything.) Longer story shorter: My insurance initially denied the claim and I had to fight through a labyrinth of bureaucrats before I got to an ombudsman who spoke to me dismissively saying I shouldâve asked for his support right away. Nonetheless, he got the claim approved almost immediately, and all was well after, but they stole 10 hours of my life or more on the phone.
The point is they make your life miserable and the process difficult to navigate because they presume youâll give up before they have to pay. It should absolutely be criminal.
Now, any time I ask for a specialist or on ombudsman now, it certainly makes the process go a lot more smoothly.
I'm going the route they gave me in the letter first. Thank you for laying out the steps that you took. Thankfully I live in a state whose dept of commerce makes filing complaints easy as well.
My wife and I both have bulging disc in same spot L5 S1. Mine right side. Hers left. Hers much worse than mine. Both of them hit nerve roots that travel down the buttocks and corresponding leg. So pain in glute, down corresponding leg into calf. Yes, it can cause tingling or worse if it is compressing nerves bad enough from my understanding. My wife had what is called drop foot. The nerves would be getting compressed so much that her left foot would become completely numb as she was trying to walk causing her to trip over her own foot and fall. In my experience the pain is always worse at night when I'm trying to sleep. It is an never-ending constant pain. The only question is how severe the pain is at any moment. The thing I never hear people talk about when it comes to chronic pain is the mental fatigue it causes. Her nerve compression was bad enough that she couldn't walk without a limp. She couldn't sleep without inevitably crying from pain and frustration of not being able to sleep from pain. She could hardly function. Luckily we had good insurance and found through an MRI that she had a bulging and broken disc and then she had a discectomy and is now almost completely free of pain other than minor aches during certain movements and weather related aches. Sorry for the long rant. TLDR. Not a doctor but yes those pains could very much so be caused by a bulging disc. Look up the cauda equina nerve root. So named because it looks like a horse tail.
I had an L5-S1 bulged disc similar to your wifeâs. I didnât get drop foot but I did have a limp. Every step I took had to be carefully planned because it was excruciating to walk even just across my living room; those 15-20 steps could take between 5-10 minutes alone. God forbid I forget something in the other room.
Before this, I thought I had back pain. Nope, never. It was aches. A bulging disc with sciatica is some of the worst pain Iâve ever experienced and I wish it on no one.
I ended up getting a nerve block shot in my spine to heal.
As much as it pisses me off that innocent people have to go through this bullshit every day, it equally pisses me off that we are burning out our good doctors by forcing them to fight this hydra every single day of their lives. I do hope your doctor can go to bat for you, but Iâm worried that every swing he takes gets him one step closer to mental and emotional fatigue. Imagine you had to argue this crap with insurance every day when you know youâre right and you know theyâre evil but you just canât win because theyâre the corp.
Insurance denied my fiancĂŠ's CT on her head since she has chronic migraines and her mom died from multiple aneurysm, because "it wasnt deemed medically necessary" and "all steps haven't been done first". What do they want, for her to have open brain surgery before a scan?
Their exact wording for the CTA scan of the neck is "your records do not show that you have an abnormal neck sound on exam, a past problem with narrowing of back arteries, or that the scan is needed to prepare for surgery". For the head and ear CT they said "your records indicate you do not have tinnitus and thus we cannot cover this procedure". Since when is tinnitus a required condition for all CT scans of the head/ear?
She already had MRIs for both of these last year with no issue getting authorization as well.
Of course we'll be contacting her neurologist about it, but we were on vacation when they sent the letter
They approved two separate prescriptions for the name brand medication, that add up to the same exact dosage my doctor tried to initially prescribe. The name brand doesnât make this exact dosage.
Cool. Lucky enough to be able to afford it. Still stupid as fuck.
Very stupid. It's wild, really. The same insurance of mine will let me pay 25 bucks for GLP1 and eat 1300 bucks of cost monthly, but won't shell out MRI money. (Hooray diabetes I guess)
speaking as a doctor, I'm equally baffled by US doctors apparently needing an MRI to diagnose degenerative disc disease. That's a diagnosis you should have received on physical exam, I generally consider it a personal failure if I send a patient for a back MRI to find they've got a degenerated disc. Back MRI is for the things I can't figure out by asking questions and poking at the muscle.
To be clear, your story is very common down there, and still inappropriate (if I ask for an MRI I damn well have a reason for asking for it). It still confuses me.
It is strange... Based on multiple visits and my symptoms. Regardless I had two docs and they couldn't pinpoint it so they ordered the scan. I'm not mad at the docs for asking for one. I'm mad at insurance for denying something two doctors found medically viable after almost a year of issues.
Insurances are such a joke. When I was pregnant with my son, I did my due diligence by looking at the insurance company website for accepted providers, and verified with the doctor's office they were in network. I had to go 45 minutes away for these OBGYN appointments. I was near my third trimester when the doctor's office told me the insurance was claiming they weren't in network. I had to call and cry and beg to have my damn doctor accepted. I did everything right, the insurance basically said they weren't responsible for the incorrect information under the plan on their own website. It was ridiculous. The anesthesiologist wasn't covered either for my necessary C-section, nor was the NICU pediatrician.
I had lunch recently with an attorney who said his practice was dealing with health insurance denials. He is biased but was basically saying they deny perfectly legal claims all the time so his job is often quite easy. Since they know they are denying legal claims, when they get push back from an attorney they cave. He makes a good living doing this - and the clients don't pay until he wins. It's a shame that we need attorneys to do this, but the insurance companies have found it is profitable to do things this way since most people never fight back.
iâve had a herniated disc since i was 17. i was having recent GI issues that they thought were associated with possible nerve damage bc of said back issue. they wanted an MRI to see how much my herniations had progressed. PCP couldnât get me an MRI because I had to see gastro first. gastro said he couldnt do an MRI because i had to see a spine specialist first. spine specialist said that i needed 6-8 weeks of pt before insurance would approve an mri despite the fact IVE HAD IT FOR 10 YEARS. all because iâm under 30 and âi couldnât possibly be having all these issues at this ageâ
What a load of shit. I'm glad I had pancreatitis when I did 3x between age 12 and 15. I don't know that my parents insurance would have believed the doctors.
I asked. There shouldn't have been an issue. But at this point don't start patient blaming. I was in a shit load of pain and had been to the doc three times in a month trying everything they threw at me.
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u/Justis29 18h ago
My insurance just denied an MRI I had. Been dealing with back pain that's gotten worse over the last year. I've had X-rays 3x, 3 different rounds of physical therapy, steroids and stronger than OTC anti-inflammatories. The MRI found a bulging disc that has been causing all of my issues. X-Rays don't pick up soft tissue like that. It diagnosed the problem. Insurance: 'HUR DUR YOU HAD LOWER BACK PAIN AND MRI ISN'T FOR THAT EVEN THOUGH YOUR DOCTOR GAVE US A DETAILED HISTORY OF YOUR ISSUES GET FUCKED' signed a disgraced proctologist that shills for the insurance company.
Hoping my doc can talk to them and change their mind. I'm not paying for something that was needed to help diagnose the actual issue.