Hey everyone just looking for some advice on how to proceed with my situation. I'll keep it as brief as possible and I apologize if I'm misusing any terms here.
Basically I have a 5cm tumor on my right chest wall over my ribs and liver. I'm in the process of trying to set up a surgery and have it removed so the docs can biopsy to see if it's malignant and go from there. This basically needs to happen yesterday. I've been stuck trying to get an MRI for over a month because my provider Aetna/eviCore is denying the MRI authorization due to my Dr's office allegedly not providing the imaging results of previous tests. My Dr's office says that they did so it's a moot point to argue.
I was instructed by Aetna to file an urgent/emergency verbal appeal and my Dr's office also submitted an urgent/emergency appeal. From what I understand from Aetna and Texas OPIC my provider has a maximum of 5 days to answer an appeal. It's been over a week and they have not gotten to it. I've spoken with multiple representatives who assured me it was submitted as urgent but it turns out it was not. They now say theres no deadline currently for them to review the appeal. They are also refusing to let me go through an IRO to submit an urgent appeal. Every time I ask to be transferred to their appeals dept there just happens to be no one available.
I'm at a loss as to either what to do for this process or if I should just pay for the MRI out of pocket and possibly seek reimbursement later if at all possible. Either way I can't sit around while this tumor is just doing whatever in my chest.
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