Even if your worker’s compensation case is accepted and you start receiving treatment, it doesn’t mean all your medical procedures or treatments will get the okay from the insurance company.
In Missouri, the insurance company will generally choose the worker’s compensation doctor treating the injured worker. This can create quite a lot of issues since the insurance company often chooses doctors or clinics they have a report with. But when it comes to expensive procedures like MRIs, will they cover it?
It Depends on Your Medical Condition
Technically speaking, an MRI is an established, and sometimes necessary medical procedure, which makes it eligible as long as you really need such a test done.
However, it’s also a rather expensive procedure that can sometimes be replaced by cheaper ones, such as X-Rays. Because of that, the insurance company may initially push back at the idea of an MRI if a cheaper medical procedure can be just as effective.
An MRI can’t always be replaced by cheaper tests, but is the only procedure relevant.
The insurance company has no extensive medical knowledge, so if your doctor says the MRI is the only way to get an accurate result and continue your treatment, then the insurance company should generally cover it. In fact, the insurance company has no right to interfere in your treatment at all, so if you suspect the insurance company is having too much of a say, discuss this with your attorney.
When an MRI May Be Denied, and What Should You Do
The insurance company can refuse to cover the costs of an MRI if it deems it is not necessary. Of course, they cannot reach this conclusion themselves, since they lack medical expertise, but they are at liberty to consult with other doctors to check. If their consultant recommends another procedure, this may give them all they legally need to deny the MRI.
In these cases, you can sometimes pay for this particular procedure through your own health insurance coverage, though you would have to check with that specific company first. They may agree to cover the MRI, and you can continue your worker’s comp treatment as usual.
If not, then you may need the expertise of a lawyer. If your doctor believes the MRI is the best test for your condition, yet the insurance company remains unconvinced, a lawyer may be able to step in and negotiate with them.
Do You Need a Lawyer?
Worker’s compensation cases aren’t always as simple as they first appear to be. The truth is, the laws of this program are complex and leave room for many interpretations. This is why you should always consult with an experienced worker’s comp attorney whenever you suffer a work accident or get sick because of your job.
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