You Can't Make This Up

[Squirrel1270]

Morning MS fam. I'm a bit frustrated this morning and losing what little faith I have left in our healthcare system. I need to vent.

The other day I met my new PC doc at the VA, went over issues, problems. While I was there, I had an embarrassing bout of leakage from my back end. She had asked me if I had ever mentioned this to my gastro or neuro and I had told her I'd been too embarrassed to say anything and wouldn't have said anything then if she hadn't noticed. She mentioned that it could be MS related, which I already knew, and asked if I had any lesions on my spine. I told her I've never had my spine MRI'ed. So, I called my neuro, asked if he would order an MRI for my spine, since it's never been done, and they said they'd get back to me.

Well, this is where it gets crazy. They got back to me and apparently my neuro says my insurance won't pay for a spinal lumbar MRI until I go through 3 months of physical therapy. I asked what sort of physical therapy I would have to go through for 3 months to get approved for an MRI to see if I have lesions on my spine and they didn't know. But I would have to spend 3 months, at $33 out of pocket a session, to what, work out? I can do that for free at the base gym!

[kdali]

I think that criteria is for back pain or injury, not bowel incontinence, but I'm guessing. It falls under loss of function, which usually gets approval after evaluation and documentation. The issue may be that the neuro is unaware, and if you reported it when you called, they should be requesting an in office visit to get the specifics documented 🤷‍♀️

[Squirrel1270 in reply to kdali]

I explained to them what the issue was. I even mentioned that I was making an appointment with my gastro and wanted to have my MRI before I went and saw him. I figured I'd be able to get my MRI without having to actually take time off from work and paying another co-pay just to explain what I've explained on the phone.

[BettysMom in reply to Squirrel1270]

You probably explained it to people who do not understand and do not care. All they told your neurologist is that you want an MRI of your spine. You need to make an appointment and see your neurologist in person, then you will get the MRI you want because you need an MRI for MS symptoms, not low back pain.

[Squirrel1270 in reply to BettysMom]

I finally got it sorted out. They approved my MRI after several back and forth phone calls. They told the insurance company it was for bladder incontenence and I told them I didn't care, whatever they wanted to put it down for was fine with me. We have the virtual MyChart thing where I can communicate with my Dr. online. I spelled it all out for him what my problem was. I don't know... I'm just glad they sent it through.

[kdali in reply to Squirrel1270]

Yay!! 🎉

[starlight5]

Agree, contact your neuro! I think if he learns about the bowel incontinence it will hopefully get you both a thoracic and lumbar mri fairly quickly. PT sounds ridiculous for this issue🙄 Good luck

[Squirrel1270]

I just finished up with PT for my numb leg that I've had for the past 12 years. I didn't get anything out of that either...

[Capamp]

First and foremost, I am so sorry that happened. Second, I am also a veteran and very familiar with the VA. Is your MS service connected? If it is, you should be assigned to the spinal cord clinic. If your local VA is small you may have to go to the regional VA nearest you for spinal cord clinic. They can order that an MRI be done at the VA or through their Community Care program at no cost to you. Your PCM might be able to order one as well, but maybe not. The VA has their fair share of rules. That said, I know all VAs are not equal. The regional VA in Wichita KS is exceptional. Others are total crap. You may already know everything I just said. However, if you do want to know more or have questions I'm glad to help. Hang in there!

OK, so after I posted this I saw your follow up post. I'm glad it's sorted! Still, you could perhaps save yourself some money if you can get it done through the VA.

[Squirrel1270 in reply to Capamp]

I would've gone through the VA with all of this but here in NJ we only have a small clinic. For the VA hospital I would have to drive into the middle of Philly and I refuse to go there for anything. For one thing, the hospital is disgusting. The city isn't safe and I can't drive in all that crap anymore. It's a shame. They're supposed to be building a new VA hospital closer to where I live, complete with everything, but it's a couple years away from completion. You know how it is, nothing moves very fast when it comes to the government...

[Capamp in reply to Squirrel1270]

Sigh. I get it. So sorry. Hopefully once the new hospital opens you can get better care.

[FearlessMsMimi]

I get your frustrations and totally agree, I feel the doctors aren’t thinking outside the box and writing the predetermination request correctly. If it’s for bladder leakage that says it all to me. Prior to the new rulings with insurance (the govern & dictate to our doctors now) I did do a pelvic floor P/T for several months just to find out I have nerve damage causing the right side of my pelvic floor to have no control, the damage is permanent. Again I could have told them that back then but I humored them.

I feel insurance has taken over even controlling the doctors decisions and treatment plans. So so sad.🤯

[Squirrel1270]

I couldn't agree with you more. We were talking about that just the other day how back in the day you got seen for what ailments you had. Now they have to ask the insurance company for permission first. Money seems to drive just about every decision made now a days.

[mrsmike9]

Before my husband could have his spinal surgery last year he had to have PT first. Even though you could see what the issue was on the x-ray, he couldn't even have an MRI until the therapy was done. So this is not unusual.

[Squirrel1270 in reply to mrsmike9]

Pretty crazy, when you think about it. I mean, who's to say that PT isn't going to aggravate the problem even more? But I understand, it's a money thing. People have to get paid...

[KBlake in reply to Squirrel1270]

My husband, who does not have ms, had back pain for over a year. The doctor did x rays and could not see any problem so he sent him to pt. After the first appointment the pain was so bad he could not sit at all, only lay flat. The doctors office said it would get better if he waited! Well after lying in bed for a week, they finally allowed him to get a mri, which showed a massive growth on his sacrum. He was then hospitalized for treatment. Meanwhile the insurance sent me papers saying that he was going to have to pay for the mri out of pocket because he didn't go through pt! The doctors office was able to get the insurance company to back down when they told them the mri had detected cancer, but it was crazy for a few weeks there! Gotta jump through the hoops!

[mrsmike9 in reply to KBlake]

Health insurance is such a racket. They can literally get away with murder!

[Wtfisup]

Hey there! Just want to thank you and the others for your service to our country. In high school, I had the privilege to volunteer at VA through a program called Health Occupations and Careers. The knowledge I gained from those men and women, both patients and practitioners, is priceless. I became a respiratory therapist and loved it until medically retired due to ms. I’m so sorry you are not treated with the respect you deserve. Hope today is a good day and that you’ve finally received the tests.

[greaterexp]

I used to laugh and say that insurance companies are guilty of practicing medicine without a license. Now I don’t laugh anymore.

[Squirrel1270 in reply to greaterexp]

Pretty sad that that's it seems anymore.