His insurer approved an MRI, then denied it. He forked out $2,340 in cash: Philly.com

Filed Under: Costs, Health plans, Patients

“Pelvic pain had dogged Keith Morgan for years, unresolved by stretching, hot baths, and other therapies recommended at various doctor visits over the last two decades,” Sarah Gantz writes over at our partner, Philly.com. “So when the issue flared up last August, the 56-year-old Montgomery County resident wanted to get to the bottom of it once and for all, with a pelvic MRI. A friend with similar symptoms had recently been diagnosed with a sports hernia after having the scan, and with other causes of his pain ruled out, Morgan thought maybe he had the same affliction. What seemed like a straightforward plan quickly got complicated: Morgan’s insurance plan approved the scan at one doctor’s office but denied coverage at another. A pelvic MRI is among the many services for which insurance companies require prior authorization, meaning that doctors must submit details about the procedure and why it is necessary to get the insurer’s approval. Insurance companies say the process protects patients from unnecessary medical procedures. Doctors, meanwhile, often say the practice is needless red tape that wastes their time and puts insurance bureaucracy in the middle of the doctor-patient relationship. And any patient who has reported for a medical procedure – only to be told at the last minute that their insurer has denied authorization – knows the communication problem all too well.” Sarah Gantz, “His insurer approved an MRI, then denied it. He forked out $2,340 in cash,” Philly.com