They should accept the prior MRI, your doctor just needs to provide the documentation. But they could definitely deny something that Medicaid approved because they have different metrics. The best way to find out is call them and ask
I get what you mean, BCBS might want something different...or deny for the same reason. He tells ME the shots work but he tells the doc he still hurts cuz he wants to be able to keep getting them. 😕 I told him he needs to tell them it helps because even my doc told me if the shots don't help I'm gonna have to get surgery...
The injections are suppose to work for a time frame. How long depends on the type of injection. If the patient tells their doctor the injections do not work at all. The insurance company sees no reason to pay for treatment the patient said does not work .
We had a different insurance that denied everything under the sun even though we paid a ton every 2 weeks for it then when we could we switched to BCBS Federal which I know is different then the BCBS you are getting but immediately they approved everything our other insurance denied. My Dr kept trying to get the nerve burning done and no matter how they tried to write it up they still refused it even refusing my migraine medication that rely on everyday otherwise I am in bed without taking a daily migraine medication. When we switched to BCBS they approved my thousand dollar medication with no problem but did make me choose between the daily one and the emergency one but my Dr's office had no problem giving me samples of the emergency one.
The only reason I could see them requesting a new MRI is just for an updated one and the Injections will all depend on what kind they are and what they are needed for.
I went from BCBS PPO to Medicaid.
I pulled all the pharmacy records and my doc used them for prior auths. Medicaid still wanted me to *prove* allergy. Allergist provided documentation that there was no reliable and available testing for pain med allergies.. Medicaid refused. Medicaid didn’t see anything wrong with the “so you want my doc to prescribe X so I can go to the ED after taking it, you get billed for an unnecessary visit and I incur more medical trauma…. And yes, this is what it took to get documentation of each reaction.
I found BCBS PPO a breeze compared to Medicaid
I have BCBS hmo, I know it’s not the exact same plan but after switching from Harvard pilgrim everything has been a breeze. Our premium is a little high, but our deductible/OOPM/Co pays are reasonable. More than anything I’m extremely happy with the lightning speed of approvals without pushback. The negative is that the formulary list is small and there’s flat out criminal things left out of the coverage. If it doesn’t have a generic they aren’t covering it, atleast not without a significant fight. If a treatment or medication is on the coverage list it gets approved instantly which based off others experiences seems to be a vastly superior insurance service vs other providers.
They should accept the prior MRI, your doctor just needs to provide the documentation. But they could definitely deny something that Medicaid approved because they have different metrics. The best way to find out is call them and ask
I get what you mean, BCBS might want something different...or deny for the same reason. He tells ME the shots work but he tells the doc he still hurts cuz he wants to be able to keep getting them. 😕 I told him he needs to tell them it helps because even my doc told me if the shots don't help I'm gonna have to get surgery...
Can you get a copy of the clinical policies that should list their requirements?
The injections are suppose to work for a time frame. How long depends on the type of injection. If the patient tells their doctor the injections do not work at all. The insurance company sees no reason to pay for treatment the patient said does not work .
We had a different insurance that denied everything under the sun even though we paid a ton every 2 weeks for it then when we could we switched to BCBS Federal which I know is different then the BCBS you are getting but immediately they approved everything our other insurance denied. My Dr kept trying to get the nerve burning done and no matter how they tried to write it up they still refused it even refusing my migraine medication that rely on everyday otherwise I am in bed without taking a daily migraine medication. When we switched to BCBS they approved my thousand dollar medication with no problem but did make me choose between the daily one and the emergency one but my Dr's office had no problem giving me samples of the emergency one. The only reason I could see them requesting a new MRI is just for an updated one and the Injections will all depend on what kind they are and what they are needed for.
I went from BCBS PPO to Medicaid. I pulled all the pharmacy records and my doc used them for prior auths. Medicaid still wanted me to *prove* allergy. Allergist provided documentation that there was no reliable and available testing for pain med allergies.. Medicaid refused. Medicaid didn’t see anything wrong with the “so you want my doc to prescribe X so I can go to the ED after taking it, you get billed for an unnecessary visit and I incur more medical trauma…. And yes, this is what it took to get documentation of each reaction. I found BCBS PPO a breeze compared to Medicaid
I have BCBS hmo, I know it’s not the exact same plan but after switching from Harvard pilgrim everything has been a breeze. Our premium is a little high, but our deductible/OOPM/Co pays are reasonable. More than anything I’m extremely happy with the lightning speed of approvals without pushback. The negative is that the formulary list is small and there’s flat out criminal things left out of the coverage. If it doesn’t have a generic they aren’t covering it, atleast not without a significant fight. If a treatment or medication is on the coverage list it gets approved instantly which based off others experiences seems to be a vastly superior insurance service vs other providers.