My MRI precertification sailed swiftly through my insurance company’s gatekeepers. The surgeon at the Wound Healing Center who debrided the festering puncture wound in my foot ordered the MRI because he was concerned about the possibility of bone infection. This is a serious concern for anyone, but a doubly serious one for diabetics like me.
I scoured the imaging order and everything I’ve learned from coding experts over year suggested that the paperwork was in good order, which was confirmed by the speedy precertification. The ducks lined up neatly and I’m off to the MRI center at Paoli Hospital this afternoon.
While working through the details of this little healthcare and imaging episode, I thought about my case in the bigger picture of the current healthcare reform and imaging utilization debates. From what I’ve learned from about 20 years in medical reporting, my brain tells me that my MRI order clearly falls in the realm of appropriate imaging. The prompt MRI precertification approval confirms that.
Then another thought crept into my head. What if the MRI hadn’t been ordered or authorized?
If the surgeon hadn’t ordered it, I would have presumed he didn’t think it necessary but I would have raised the question. If the insurer had denied the doctor’s request, I’d have badgered the heck out of someone. (I certainly trust doctors more than insurance companies.) Yet, like many Americans, concerns about overutilization, appropriateness, and cost tend to disappear when the utilization and cost are in my personal best interest. That’s certainly one big driver of healthcare costs in this country … and something for me to ponder in the tube this afternoon.
