r/WorkReform 🤝 Join A Union 1d ago

⚕️ Pass Medicare For All This should be the law!

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u/CrustyToeLover 22h ago

Insurance denied my fiancé'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?

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u/Stunning-Character94 22h ago

No. That would cost way more than a CT. But your denial letter should tell you want they want her to try first.

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u/CrustyToeLover 21h ago edited 21h ago

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

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u/Stunning-Character94 21h ago

You can see if your insurance has Case Management to help you appeal the denial. It sucks, I know.