MRI Gone bad Help!

[ziploc]

I am in California and a year and a half ago I went to see my Primary Care Physician he referred me to receive an MRI. At the time I had PPO coverage. The next day I went down to San Jose Medical Group to receive my MRI. I gave the receptionist my Insurance and paid my $40 co pay.

This is where it gets bad. They billed my carrier incorrectly stating that it was a routine physical exam. I had already had one that year so my carrier only wanted to pay $250. I finally got that straightened out after 6 months.

Now my carrier is trying to only pay half saying I didn't receive prior authorization...but I did. The only hitch is that supposedly my doctor recommended I go to San Jose Medical Center....not Clinic. Should this matter? The Group is a part of my carriers network, and I did have pre-authorization from my primary physician to receive an MRI.

Please help and Advise

Thanks Ton

Ray

 

[CIAA]

ziploc,

You should have received a "benefit determination notice" that would have included instructions on how to appeal their decision. It sounds as if you may be able to prevail on appeal.

 

[ziploc]

It is in Appeal right now..and taking a long time. At the time I had private coverage but I now have my current employers HR Manager helping me out. I guess I am a little worried because they want $2500 and have sent it to collections...that's on hold as well.

Thanks for your reply

RAy