What is Magnetic Resonance Imaging (MRI)?
Magnetic resonance imaging (MRI) uses computer-generated radio waves and a magnetic field to create very detailed images of the tissues and organs in your body. Your body goes through a large tube-shaped machine that realigns water molecules in your body via a magnetic field. These aligned atoms produce faint signals through radio waves, that then create cross-sectional MRI images. An MRI machine can also produce a 3D image that can be viewed from different angles.
Magnetic resonance imaging is a non-invasive way to examine organs, tissues, and the skeletal system, providing high-resolution images of the inside of the body. MRIs are most frequently used in the brain and spinal cord to diagnose aneurysms, stroke, spinal cord disorders, multiple sclerosis, brain injury resulting from trauma, tumors, and disorders of the eye and inner ear. A functional MRI of the brain (fMRI) produces images of blood flow to specific areas of the brain.
MRIs can be used for the heart and blood vessels to determine the extent of damage caused by a heart attack or heart disease as well as to check for tumors or abnormalities in many organs in the body. Bone and joint MRIs can help diagnose torn ligaments or cartilage, bone infections, bone tumors, or disc abnormalities.
Is Magnetic Resonance Imaging Medically Necessary?
An MRI can be an invaluable resource to diagnose a patient when an X-ray or CT scan does not provide sufficient information. When a physician determines there is a deeper cause for pain or chronic headaches, an MRI scan can help determine the cause. It can be very difficult to determine an “ideal” treatment for a condition when the physician doesn’t have all the necessary information. Symptoms of chronic pain in a body area along with fever, weight loss, body weakness, or numbness can definitely indicate the necessity for a magnetic resonance imaging test.
Does Insurance Cover Magnetic Resonance Imaging?
Since an MRI can range from $400 to $12,000, it is important that you ask about the cost and determine whether your insurance will pay for the procedure before you have it done. Price can depend on the place of service, your specific health insurance, your location, whether extra medications are required, your provider, and the body part scanned. Some insurers may require pre-authorization for an MRI, while others may require high copays or coinsurance amounts.
An “open” MRI is typically less expensive than a “traditional,” or “closed” MRI. If your doctor orders an MRI scan with contrast, you can also expect it to be more expensive. If you are claustrophobic, you may require a sedative, which will affect the cost of the MRI scan. Neck and brain MRIs are usually the most expensive, although a bone MRI (such as a knee) can run from $410 to $2,100.
Why are Claims for Magnetic Resonance Imaging Denied?
While it is unlikely that your insurer would deny your claim for an MRI scan by saying the procedure is experimental, it may claim the scan is “not medically necessary.” The insurance company may require your physician to first perform x-rays and a CT scan to determine the cause of your medical issue because those tests are much less expensive. If your doctor believes an MRI is necessary, yet your insurer deems it “not medically necessary,” you must contact an experienced magnetic resonance imaging insurance denial lawyer from the Law Offices of Scott Glovsky. Scott and his legal team will be the strong advocate you need to ensure your insurer pays for necessary medical tests.
What Should You Do if Your Coverage for Magnetic Resonance Imaging is Denied?
If your insurer has denied your claim for an MRI, your doctor can contact the insurance company and request that it reconsiders the denial. Your doctor may also make a request to speak with the medical reviewer of the insurance plan as part of a “peer-to-peer insurance review,” to challenge the decision. If none of these steps are successful, it may be time to contact an MRI insurance denial attorney from the Law Offices of Scott Glovsky.
What Insurance Companies May Be More Likely to Deny Magnetic Resonance Imaging?
While any insurer may deny MRI coverage, some companies may be more likely to do so. Anthem Blue Cross, Blue Shield, Health Net, Kaiser, UnitedHealthcare, Aetna, or any other medical insurer may try to deny coverage for an MRI scan. It is essential that you get help to persuade the company to pay for this necessary procedure.
Summary of a Case That We Filed
- We filed a case against Oscar Health Plan of California for denying a medically necessary MRI for our client. Our client had numbness and weakness in his lower extremities. His doctors requested MRIs to determine the cause of his symptoms. However, Oscar Health Plan denied the crucial requests, delaying his care for months and causing lasting physical injury and emotional distress. Our lawsuit alleges that Oscar’s system for reviewing requests for medical care is designed to deny medically necessary care to its subscribers, placing barriers in the way of members receiving necessary care and designed to save money for Oscar. As a result of Oscar’s wrongful denial, our client suffered physical injury, emotional distress, and other damages. We are suing Oscar for breach of the duty of good faith and fair dealing, breach of contract, and violation of Business & Professions Code Section 17200.
How the Law Offices of Scott Glovsky Can Help
If your insurance company won’t approve MRI testing, it can be extremely beneficial to speak to attorney Scott Glovsky. Scott has experience working on the other side after working in large corporate law firms defending insurance companies in bad-faith lawsuits. This gives him a unique perspective on how large insurance companies think and operate—and allows our firm to stay one step ahead of their legal strategies.
When you choose the Law Offices of Scott Glovsky, you are choosing a firm that is well-respected and has a solid reputation for helping people in the same situation. Attorney Scott Glovsky offers personal, empathetic client attention, along with a commitment to hard work and a successful track record. Following an MRI insurance denial, contact the Law Offices of Scott Glovsky.