What would you do if you’re a runner and you were told you’re going to have to wait six months to get an MRI in order to make a decision about what you would do for treatment? What would you do? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just got a call from a guy that I’ve seen a number of times over the years, and he’s an ultra-marathoner. He is not a wimp. He’s a tough guy. He’s very smart. He knows his body really well, and he got what we suspected was a partial tear in the plantar fascia. Now, his whole story, how it started, how he felt it when he was on a run, it’s all the classic description of a partial rupture of the plantar fascia in terms of the history that we think of as fitting that story.
He didn’t get better. He took weeks off. He couldn’t run. He couldn’t even hike, it was killing him, so I ordered an MRI. I wrote up an order for his MRI. I’ve sent it to the facility. I wrote up all the details about what’s been going on with his story and how he wasn’t getting better with all of these things that he had tried, which basically proved that this is medically necessary and completely justified, and they should pay for it. Well, the insurance company denied prior authorization for his MRI.
He called me then, very disappointed. He said, “The insurance company said I have to have heel pain for six months before they will let me have the MRI.” Okay. Now, first of all, I think this is crazy. If you think that we have the best healthcare in the world in the United States, I don’t know where you live exactly, or what kind of insurance you have, but make no mistake, the insurance companies are making decisions about what’s happening for you if you let them, but you do have other options.
The first thing is that there’s no way any runner would just stop running for six months waiting for an MRI. That’s complete insanity. But one option is you could get an ultrasound study. In his case, I could actually go to his house and look at his foot, with ultrasound myself, and get it done even the same day, potentially. That’s one option.
Another option is you could just go pay for the MRI. If you pay for it and your insurance won’t pay for it, you are going to get a cash discount depending upon how important it is to you. Well, it may be worth paying for that. The third option is you could just go ahead and treat the injury like it’s a partial rupture. But because that’s usually a little complicated and it really does involve some difficult things you have to do, you may not want to do that without looking at it first to prove to yourself that it’s really necessary for you to do this routine that’s going to actually really treat the partial rupture of the plantar fascia.
You can do that with ultrasound. You can do it with an MRI. But you have to remember, the insurance company is not on your team. If you think they’re looking out for you, you’re really confused. Trust me, I’d rather have any of you listening to this right now as a pacer at my ultramarathon than somebody from the insurance company. They are not going to help me finish. In fact, they’re probably going to try to trip me when I’m running downhill.
You got to look out for yourself. You have to think about what’s right for you. You got to get a second opinion. You’ve got to figure out what the other options are if your insurance company is trying to prevent you from getting something that’s medically necessary. Really frustrating, but it’s part of what we have to deal with. If you like this episode, please like it. Please share it. Please subscribe, and I’ll see you in the next training.
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