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GBenjamin Asked January 2015

I felt as did neurologist that Dad needs MRI and EMG. There was a question of pay since NOT medical emergency. Any advice?

Dad still in rehab and they say not covered. Yet I feel he is struggling because something else might be going on. Day 74 in rehab and dad sleeping more. In fact hurt twice by nurse pulling his head and banging his hand badly. Which is current reason for not doing rehab. Wrist was a bit swollen.

pamstegma Jan 2015
If you could talk to the Radiologist, he may have an answer.

GBenjamin Jan 2015
I was wondering about MRI with hip replacement. As far as coverage he has Medicare and his civil service insurance. Plus hospitalization policy. Not sure if surgery caused this complication and or the medicines are causing problems.

Rehab nursing home already hurt his neck and two days ago bruised his wrist. X Rays were negative but quite a bit swollen. Yet rehab not happy if not doing TP or OT. Yet neurologist over a month ago suggested these tests. I just got notified last week by rehab center.

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pamstegma Jan 2015
I see that Dad had hip replacement. MRI may be denied due to the metal screws or the type of metal in the implant. The Neurologist should consult with the Orthopedic Surgeon about other imaging options.

jeannegibbs Jan 2015
"Because it is not a medical emergency" sounds like it has to be pre-authorized by insurance before it can happen, in order for the insurance to pay for it. This is often the case when wanting to use a supplier "out of network."

Talk to the insurance company. (You may need Dad's permission unless you have POA) and find out how the MRI and EMG can be covered. Is it just a matter of using an in-network provider? Do they need a justification from the neurologist? Or a different doctor who is in-network?

I think insurance typically covered MRI and EMG procedures, but there may be particular requirements with Dad's insurance. Talk directly to the insurance company's customer service people.

pamstegma Jan 2015
Not covered by whom? Who is the insurance carrier? I know if the MRI provider is out of network (not contracted) it won't be covered.
If he is Medicaid, does he have a Medigap policy?

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