Tell Me About Medicaid Denials

[fureverywhere]

I finally got back to the podiatrist after a year. He ordered an MRI and Medicaid denied it. I understand that now he has to call their person who passes judgment and explain why it's needed. I'm sure many of you have far worse managed care stories. But just so frustrating. I can read the first request in flat medical text-pain in right ankle, required is physician monitored exercise program.

What they don't know is I've been exercising for a year hoping it would shore up something. Great so they see I've been doing 5-10 miles most days, can't be hurtin' that badly right? Somebody making a judgment based on a report, not an exam. My right ankle looks visibly different. Plus there's a difference between "discomfort" and " I don't know if I can make it from the driveway and up the front steps". Can the doctor appeal this somehow?

 

[Butterfly]

Medicaid is different state by state. The doc can probably appeal the decision, but he'll have to put in some stuff about how bad it is and how it is affecting your life and hindering your search for employment and is "medically necessary" or they'll probably just turn it down again. Medicaid here requires people to go through all kinds of documented preliminary stuff, like PT, before they'll authorize advanced testing like an MRI for an orthopedic thing. Sucks.