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Issues with Insurance

Right now I am with an HMO and currently with a neurologist for a persistent visual aura without infarction. I have been unsatisfied with my treatment with my neurologist, and the treatment that I am getting is absolutely not working for me. I ended up paying out of pocket to go see a specialist out of network to get a second opinion. This doctor absolutely understood my condition, knew the right treatment to move forward, and suggested preemptive tests to rule out secondary conditions that might be related. I absolutely agree with everything the specialist recommends. However, because they are out of my insurance network, my medications and tests would not be covered. They want blood work, head MRV, and a spinal tap.

My options are to go back to my neurologist with the suggestions from the specialist and hope they will agree to run the tests and let me take the results back to the other doctor, and hopefully fulfill the prescriptions as well. Or I can wait until open enrollment, which I think it may?, and get insurance through work, then get the test but still probable have to pay the deductible.

I have found a few options to help pay for my medications without going through my network, but what is the best way to try and get my network to cover the head MRV, spinal tap, and blood work from the recommendation of an outside doctor? Would I be right to assume that I would need my neurologist to order these, and that I couldn't bring these to my primary care doctor? I have had issues communicating with my neurologist, but have an in person appointment scheduled next month.

  1. Hi ADCD,

    Thank you for sharing your story and being here with us!

    I understand how frustrating insurance can be - nothing ever seems to be easy. I think it depends on your insurance plan whether or not your neurologist or primary doctor can order the tests. I would encourage you to have all your doctors work together so you get the best care. That may mean having the doctors talk to one another and having your local doctor follow the specialists care plan. This is done frequently.

    If it were me I would contact my insurance company and see what they say.

    Please let me know how you make out,

    or create an account to reply.