Are You Covered

I am sharing this personal story because the financial outcome would have been extremely expensive if I had not known I can make the choice.  If you have any feedback after reading this, please email me.

A month ago, my neurologist recommended I have three MRIs.  The neurologist wrote my MRI orders on Rolling Oaks’ form also known as Rad Net.  I cringed as I already had a negative experience with Rolling Oaks in 2017 which I will share later in this blog.  It took three weeks to get into Rolling Oaks even though I called immediately from the neurologist’s parking lot.  Upon arrival to the appointment, I was told that the insurance company has not completed the authorization and that my patient responsibility is over $1700 and must be collected before the exam.  They also said I would need to sign a waiver stating that I would be responsible for the entire cost of the three MRI’s if the insurance company denies the authorization. 

I questioned why they had not told me about the authorization days before my appointment so I could call the doctor and the insurance company myself.  The manager Paul stated they see 1000 patients per week and will process authorizations the day before appointments.  Essentially, this means that any additional information the insurance company needs may extend beyond the one day they dedicate to processing authorizations.  In my case, the insurance company required a peer-to-peer which is a phone call between my doctor and the insurance company doctor.  That may take a day or two, which it did.

When I questioned Paul about their processes on this day and with my 2017 experience, Paul stated they it is corporate policy to collect payment up front and that he only gets about one complaint per week out of the 1000 patients they see. 

I had Paul return my orders and went to my car to Google the closest Grossman Imaging.  Grossman was only a few buildings away.  I walked in and asked the front desk if they could perform these tests with these order.  She immediately stated yes and would have to obtain authorization.  The front desk scheduled my appointments for the following week pending authorization.  She stated someone would call me the day before my appointment to provide status on authorization.

The day before my test, the authorization department called and stated authorization is still pending peer to peer.  She stated that I can sign the waiver (same as Rolling Oaks) and be responsible financially if authorization is denied but she advised against it.  She stated it would be worth it to wait for the authorization and not take the risk of a denial as it would be very expensive.  This is a compassionate, knowledgeable individual and I was immediately grateful for her advice.  She stated the peer to peer can still happen today so she would call me in the morning for the latest update.  I got a call an hour later that everything was approved.

When I showed up to my MRI, I was told my co-pay is $250 per visit.  I was grateful to pay Grossman the $250.  In addition, the front desk tried to see if the MRI appointment for next week can be conducted right then and there so I could avoid having to pay an additional $250 co-pay.  They successfully accomplished this and I had the three MRIs for $250 instead of $1700+++. 

In 2017, I had to have a CT scan following sinus surgery.  Orders were written for Rolling Oaks.   When I checked in for the appointment, the frost desk told me they have to collect the $250 patient responsibility up front.  They actually refused to conduct my CT scan unless I paid them $250 because their computer said that is my out-of-pocket cost for the CT scan. I told them I had exhausted my out-of-pocket maximum for the year and there is no way I have to pay the additional $250.  I did not have the scan until the next day as I refused to pay until they actually called the insurance company.  I was right and they apologized for the error. 

Here are some pointers to help you or your loved one navigate in similar situations if you have PPO insurance:

  • Confirm the imaging center or lab or other facility of in-network.
  • If the imaging center, lab or other facility is not in-network, go to the one that is in-network.
  • You choose your provider – not your doctor.
  • Keep your Explanation of Benefits in a file each time you receive them from the insurance company.
  • Download your insurance company’s app on your phone to check for in-network providers, access your insurance card information and see you out-of-pockets costs instantly.
  • Speak up!  If the outcome if different than you expect, speak up to the doctor, your insurance agent/broker and the insurance company.
Coast General Insurance Brokers