Hi All,
I'm new to this thread, but just started reading it recently. I'm the parent of a 20-something who has been diagnosed with ME/CFS, POTS, and MCAD. Although she doesn't have EDS, she is on the hypermobile spectrum. Practically all prior treatments to date have not helped her. Due to the articles that
@JenB and
@jeff_w originally published, I became aware that CCI might be contributing to her condition.
Her PCP agreed to write the order for the appropriate upright MRI's. But, when he found that those tests needed prior authorization, he said he'd have to 1) examine my daughter for this condition, and 2) have a consult with her to even have a chance of getting prior authorization from insurance. Without these, he seriously doubted that a peer to peer consult for the prior authorization would get approved. My concern is that even if we met conditions 1) and 2), we still may have a problem with insurance prior authorization.
For one, I understand that CCI is not diagnosed upon physical examination. So, I'm not sure what a physical exam would prove. And two, even if he believes that CCI could be an issue, I doubt the peer doctor at the other end of the prior authorization would be so inclined to approve the imaging.
So, my question is whether others have faced insurance issues with imaging, and what they did to overcome them. Is there some study or paper that I should bring to my daughter's doctor's office for reinforcements? I'm sure Drs. Bolognese and Henderson have written papers on the subject, but I'd rather ask what others' experience has been vs. just starting an insurance battle from scratch.
Many thanks in advance for advice.