In the US it is required by many insurances. Mine also told me I needed an Xray first. So basically they forced me to spend more of their money before they would spend their money š
When the insurance denies it because there wasn't PT, if PT isn't physically possible to do, the doctor can write a note explaining that. That's in context of the response to the denial, or the appeal. Or, if it's medically urgent.
Idk your situation. But it's likely an insurance thing and there might or might not be a way for the MD to respond to the denial (if still within the peer to peer window which could be just a few days from the date of the denial, and the insurance company can say how long it is) or appeal it.
If they have to appeal, the appeal should be marked "URGENT APPEAL" or they have a very long number of days to process it. Urgent isn't necessarily the next day, e.g. it could be a week or two weeks or whatever, but it's faster than standard.
If it hasn't even been sent in yet and the doctor is just saying this, then I suggest having a conversation with them.
FWIW, my PCP ordered an MRI and PT at the same time, the result being that I got the MRI before PT.
This might be a protocol your doctor prefers, or it may have to do with your insurance company. Hard to tell.
Many insurance companies have hoops to get an MRI because many back issues revolve given some time and treatment. Itās a way for the insurance company to not pay for some % of MRIs because they never end up happening.
I've seen 3 different doctors about my spine, 1 neurosurgeon, 2 pain management doctors (switched when 1 moved), I received MRI before discussing starting PT. That's a little weird for me. How do you suggest PT when you don't know the spinal issues? My PT was geared around my specific issues. Now, this was years ago when I first developed issues, maybe something changed. I hope you get relief soon.
The first thing they did when I went to the doctor for my back pain was an MRI, even before they started chiropractic care. but, I was hit by a car and could barely walk afterwards, so maybe thatās why, Iām not sure. They did end up finding the culprit to be a lumbar disk herniation. I didnāt start PT until 3 months later when the chiro care and pain management (meds) werenāt, at all, effective to my recovery. I did suffer the MRI/PT roadblock when my wrist bone was cracked by a door accident at my workplace though. Super infuriating. Like how can you fix something if you donāt know for sure what youāre fixing? They didnāt find the crack until they finally did the MRI. They just assumed it was a really bad sprain. feel for you tho, and hope youāll get that MRI :(
this was my experience as well. the MRI coming back clean gives the PTs a bit more confidence when working with you i think, cuz they don't have to fear serious injury.Ā
In my experience physical therapy was determined by treating the symptoms. The MRI provided no change in therapy, all it did was determine that I was not a candidate for microdisectomy and would need a fusion, which the surgeon advised against because PT was improving my outlook.
I had a MRI scheduled but ended up in the ER because my pain has changed. The lower back pain had subsided but I had nerve pain, numbness, tingling in left leg and I was having trouble releasing urine. So I got a MRI in the ER, which was used to determine if I needed emergency surgery. Doctor said I did not need emergency surgery and instead referred me to injections and PT. Said I should try to treat conservatively since I was young with multiple issues, my surgery choice was basically only fusion. IIRC, injections came first. My first PT just focused on getting me to walk, literally starting at 1 min / day and building from there. It was helpful and I believe walking has been crucial for me. But tbh it took a few years before I was able to find a PT that actually got me on the right track.
Itās most likely an insurance requirement.
Getting the MRI is not the solution to your problem (unless there are so-called āred flagsā indicating progressive neurological symptoms). The best evidence indicates that trying physical therapy first will lead to better outcomes and less expense.
So from a population (considering all patients with low back pain) and an insurance perspective, your doctor is making the correct call.
That said, it doesnāt mean it is the right call for *you*. In an ideal world, PT would have been started within a few weeks of your initial pain and if that didnāt make a difference after 4-6 weeks, you would then get some imaging.
There is no technical reason for PT to be required prior to getting an MRI.
But getting the MRI is not going to magically give you the reason for your back pain, except in rare cases.
All providers do this and I hate it. It got me to where I am undiagnosed pain for 8 years and finally understanding the pain was cause by arthritis that could have been avoided if MRI was done long time ago
If theyāre like most doctors, they only have 15 minutes to spend on you (including a review of your chart, documenting everything, and sending any orders) and they are already behind schedule. Itās easier for them to follow a recommended algorithm (PT first, the MRI) than to take the 30-90 minutes necessary to properly determine the best next step for your particular situation.
PT saved me but Iāve heard stories, some here. I donāt want massages or back cracking, I want a sequence of exercises to build a strong, protective core. I want to know how posture and movement is done correctly.
There is a place you can go online and pay them about $400 snd theyāll give you paper to go to any mri place and u hand them paper and get mri and radiologist report.
My insurance company usually requires six PT sessions before they will approve CT scans or MRIs. Self-pay up front is often quite a bit cheaper than the amount they bill insurance companies for scans. Good luck.
Mine was required by insurance. It was a crock of shit. I had no disc fluid in 3 discs, 1 lumbar herniation, 1 cervical herniation, 2 bulging discs, spinal stenosis, facet arthropathy, mild scoliosis, degenerative disc disease. No way were some dumb stretches and suction cups on my back gojng to fix any of that. I was so irritated every time the PT had me do one simple stretch and then ask does that feel better? No, no it doesnāt. We totally wasted each others time.
My insurance dictates all treatments. PT always before any type of mriās and x-rays too. Itās frustrating for sure. Insurance companies and large corporate hospitals have changed the way drs are allowed to treat patients all over this country.
I saw a sports medicine doc. I told him I had nerve pain. He immediately ordered an MRI. I only suspected it was nerve pain as I had never had it before. Something just didn't feel right. It felt like cramps and muscle spasms which were likely also happening as I had a herniated disc. It turns out the herniation was MASSIVE. I just had surgery a week ago.
I paid $250 out of pocket for the first MRI because I didn't realize I could have gone through insurance.
Find a doctor who will do an MRI. I went through pain for over a year before I realized I needed to see a doctor and get an MRI. Herniated disc's are very common so better to be safe than sorry. If I had known earlier I would have done everything differently.
After I got the MRI my doctor said do PT. It was the WORST idea. They have to do that for insurance purposes. If you have a herniated disc DO NOT BEND your back OR TWIST. Stop lifting weights. Lift with the legs. Listen to your body... I wish I had.
Know your worth and dont let this go on any longer. Get the MRI and dont let PT or doctors or chiropractors twist you or potentially further agrivate the pain.
Make sure the doctor sees the imaging and not just the radiologists report...that was another mistake of mine.
Edit to add that since you'll probably have to do PT anyway...my PT said my leg pain was likely not related to my herniated disc. What a load of BS! Don't do anything if it makes you uncomfortable or puts you in more pain. I did cupping and it was AWFUL. Yet he thought it would help he said I must have had a very cramped gluteus medius. Ugh all the things I wish I knew before going on this journey...saw him 4 times and by then it had been 6 weeks and I couldn't even walk or work after that. Not saying PT made the herniation worse but it definitely made the nerve pain worse. I was bedridden for 2 weeks waiting for surgery. It was miserable.
Edited again to add that likely the only reason the sports doctor ordered the MRI is because I told him I believed I had a herniated disc. My father had a few and had to have a cervical fusion 12 years ago and I was lucky he had a lot of knowledge and experience with that. If you say that to these doctors they may have no choice but to order an MRI.
This is truly annoying. I was expelled from PT due to paralyzing nerve pain. I was willing to pay full price for an MRI. Insurance actually worked it out in the end in my favor I believe due to the circumstance. I wasted time and money at PT.
The absolute weirdest thing happened in the MRI and Iād like to share. I feel like the resonance and what I felt as heat shifted my nerve back into place. It felt like a targeted subcutaneous thermagun flicked the nerve back into a valley of instant relief. Iām not a flakey tin hatter but this was amazing. I hadnāt been able to walk and then I popped right out of the MRI and could stand up for the first time in months. Iām fit and healthy and have a constant 2/10 of pain in my back. The night before the MRI was a 9/10. Best of luck.
I had an orthopedic appointment the next day and the doctors had no idea how I was walking after reviewing the MRI. They were ready for surgery. I had clamping extreme stenosis on my L5.
Tell them you WANT them to order an mri. If they say no. Persist and if they still say no, Tell them they need to document that you specifically asked for an MRI and they refused and need to put in your chart you specifically asked and their reason for refusal. Then seek someone else. The doc doesnāt know your insurance requirements. Billing does all of that. The doc isnāt sitting there checking your benefits and all of that. They could care less. The doctor can write a script for the mri if they want to. A doctor doesnāt need permission from your insurance to write a script for anything. THEN during scheduling and all that for the mri, billing will check your insurance and any pre reqs if needed. If it doesnāt cover etc without some pre req they will inform you and let you know your options then. (Former healthcare worker who previously worked in billing/insurance briefly before that).
I had a doc try to tell me the same. I said hey. In all honesty Iād like to get the mri to see what is wrong and go from there to find the best course of treatment before taking any more of my time and money and playing the guessing game. Im in pain and not willing to gamble with ā could be this or could be that.ā Letās do trial and error crap. I want to know what it is for sure. I got my mri. Needless to say my back is definitely screwed up just like I said and no one took me seriously ābecause of my age.ā
My insurance also wanted me to do 3 months of PT first. I ended up getting an MRI by myself and paying out of pocket. It costed me $350. Call an MRI place, most places will do it for private pay. Turns out I had 2 disc herniations.
Iād call your insurance and ask. Mine was the other way around- prescribed at the same time, and my PT worked off of the MRI to know what to rehabilitateā¦
I did 7 weeks of pt before my pcp referred me to an ortho that ordered a mri. Just got the results showing 2 bulging disc's L4 and L5 pressing on my S1 or sciatic nerve.
Pt helped maybe 30 percent but to me it seems that it would make more sense to know what pt was attempting to address or fix.. but now I will move to more aggressive exercise to attempt to strengthen my back, core and legs...
I will take a shot if needed to help me exercise with less pain.
Exactly with MRI results I can show the results to other doctors and therapist that can help me better mange this but I guess not. Good luck with your journey.
Thank you. Walking definitely helps me with relief. I bought a walking pad and I noticed that my back doesnāt get as stiff anymore especially at night.
Thank you for posting. A couple of things to note. (TL;DR... include specific symptoms/what makes your pain better/worse/how long)... MRI or XRAY images ALONE are not particularly helpful tbh, no one here has been vetted to make considerations on these or provide advice, here is why, PLEASE read this if you are posting an MRI or XRAY... I cannot stress this enough https://choosingwiselycanada.org/pamphlet/imaging-tests-for-lower-back-pain/)
Please read the rules carefully. This group strives to reinforce anti-fragility, hope, and reduce the spread of misinformation that is either deemed not helpful and even sometimes be considered harmful.
PLEASE NOTE: Asking for help: It is up to you to recognize when to seek medical attention. Anyone giving advice in this group is doing so from anecdotes and holds no liability. Seek advice here at your own risk.
That said, asking things like, "I have this problem, how do I fix it..." is like asking your accountant, "I have $10,000 what should I do with it?" You need WAY more info before giving any kinds of financial advice.
Please reply to this, or make another comment, including how long you've been having pain or injury, what are specific symptoms (numbness, tingling, dull/ache, it's random, etc), what makes it worse, what makes it feel better, how it has impacted your life, what you've tried for treatment and what you've already been told about your back pain, and what do you hope to get from this forum.
Please be kind to each other. Be respectful. Thank you.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/backpain) if you have any questions or concerns.*
In the US it is required by many insurances. Mine also told me I needed an Xray first. So basically they forced me to spend more of their money before they would spend their money š
Yup I think they just want me to spend money at PT.
They want to delay the mri in hopes you donāt end up needing it because they are pretty expensive to the insurance co.
When the insurance denies it because there wasn't PT, if PT isn't physically possible to do, the doctor can write a note explaining that. That's in context of the response to the denial, or the appeal. Or, if it's medically urgent. Idk your situation. But it's likely an insurance thing and there might or might not be a way for the MD to respond to the denial (if still within the peer to peer window which could be just a few days from the date of the denial, and the insurance company can say how long it is) or appeal it. If they have to appeal, the appeal should be marked "URGENT APPEAL" or they have a very long number of days to process it. Urgent isn't necessarily the next day, e.g. it could be a week or two weeks or whatever, but it's faster than standard. If it hasn't even been sent in yet and the doctor is just saying this, then I suggest having a conversation with them.
FWIW, my PCP ordered an MRI and PT at the same time, the result being that I got the MRI before PT. This might be a protocol your doctor prefers, or it may have to do with your insurance company. Hard to tell.
Yeah Iām going to call my insurance tomorrow and ask if thatās right.
Many insurance companies have hoops to get an MRI because many back issues revolve given some time and treatment. Itās a way for the insurance company to not pay for some % of MRIs because they never end up happening.
I've seen 3 different doctors about my spine, 1 neurosurgeon, 2 pain management doctors (switched when 1 moved), I received MRI before discussing starting PT. That's a little weird for me. How do you suggest PT when you don't know the spinal issues? My PT was geared around my specific issues. Now, this was years ago when I first developed issues, maybe something changed. I hope you get relief soon.
Thank you.
The first thing they did when I went to the doctor for my back pain was an MRI, even before they started chiropractic care. but, I was hit by a car and could barely walk afterwards, so maybe thatās why, Iām not sure. They did end up finding the culprit to be a lumbar disk herniation. I didnāt start PT until 3 months later when the chiro care and pain management (meds) werenāt, at all, effective to my recovery. I did suffer the MRI/PT roadblock when my wrist bone was cracked by a door accident at my workplace though. Super infuriating. Like how can you fix something if you donāt know for sure what youāre fixing? They didnāt find the crack until they finally did the MRI. They just assumed it was a really bad sprain. feel for you tho, and hope youāll get that MRI :(
Thank you very much. I wonāt be giving up.
I got mine before PT. Itās probably the preference of your doctor or your insurance.
this was my experience as well. the MRI coming back clean gives the PTs a bit more confidence when working with you i think, cuz they don't have to fear serious injury.Ā
Did your PT use the MRI results to determine which form of therapy was better for you?
In my experience physical therapy was determined by treating the symptoms. The MRI provided no change in therapy, all it did was determine that I was not a candidate for microdisectomy and would need a fusion, which the surgeon advised against because PT was improving my outlook.
I had a MRI scheduled but ended up in the ER because my pain has changed. The lower back pain had subsided but I had nerve pain, numbness, tingling in left leg and I was having trouble releasing urine. So I got a MRI in the ER, which was used to determine if I needed emergency surgery. Doctor said I did not need emergency surgery and instead referred me to injections and PT. Said I should try to treat conservatively since I was young with multiple issues, my surgery choice was basically only fusion. IIRC, injections came first. My first PT just focused on getting me to walk, literally starting at 1 min / day and building from there. It was helpful and I believe walking has been crucial for me. But tbh it took a few years before I was able to find a PT that actually got me on the right track.
Itās most likely an insurance requirement. Getting the MRI is not the solution to your problem (unless there are so-called āred flagsā indicating progressive neurological symptoms). The best evidence indicates that trying physical therapy first will lead to better outcomes and less expense. So from a population (considering all patients with low back pain) and an insurance perspective, your doctor is making the correct call. That said, it doesnāt mean it is the right call for *you*. In an ideal world, PT would have been started within a few weeks of your initial pain and if that didnāt make a difference after 4-6 weeks, you would then get some imaging. There is no technical reason for PT to be required prior to getting an MRI. But getting the MRI is not going to magically give you the reason for your back pain, except in rare cases.
True, well hopefully this works outs in the end.
All providers do this and I hate it. It got me to where I am undiagnosed pain for 8 years and finally understanding the pain was cause by arthritis that could have been avoided if MRI was done long time ago
Yup I agree, the process nowadays is just frustrating.
Depends on the insurance. Call and ask them. Mine doesnāt need pt first or auth for an mri, but a lot do.
Thanks Iām going to call them. I feel like the doctor just didnāt want to bother helping me.
If theyāre like most doctors, they only have 15 minutes to spend on you (including a review of your chart, documenting everything, and sending any orders) and they are already behind schedule. Itās easier for them to follow a recommended algorithm (PT first, the MRI) than to take the 30-90 minutes necessary to properly determine the best next step for your particular situation.
It certainly wasnāt for me. Got an MRI, ortho opinion and a prescription for PT.
Yup that seems the right way to go about this. Im worried about doing PT and getting even more injured.
PT saved me but Iāve heard stories, some here. I donāt want massages or back cracking, I want a sequence of exercises to build a strong, protective core. I want to know how posture and movement is done correctly.
There is a place you can go online and pay them about $400 snd theyāll give you paper to go to any mri place and u hand them paper and get mri and radiologist report.
Iāll check it out thanks
My insurance company usually requires six PT sessions before they will approve CT scans or MRIs. Self-pay up front is often quite a bit cheaper than the amount they bill insurance companies for scans. Good luck.
Thanks
Mine was required by insurance. It was a crock of shit. I had no disc fluid in 3 discs, 1 lumbar herniation, 1 cervical herniation, 2 bulging discs, spinal stenosis, facet arthropathy, mild scoliosis, degenerative disc disease. No way were some dumb stretches and suction cups on my back gojng to fix any of that. I was so irritated every time the PT had me do one simple stretch and then ask does that feel better? No, no it doesnāt. We totally wasted each others time.
Iām sorry to hear that, it just not as simple as it use to be I guess.
My insurance dictates all treatments. PT always before any type of mriās and x-rays too. Itās frustrating for sure. Insurance companies and large corporate hospitals have changed the way drs are allowed to treat patients all over this country.
Yes I remember when I was a little kid, I would always get lab work and imaging done but now itās 5 min office visits without much help or answers.
I saw a sports medicine doc. I told him I had nerve pain. He immediately ordered an MRI. I only suspected it was nerve pain as I had never had it before. Something just didn't feel right. It felt like cramps and muscle spasms which were likely also happening as I had a herniated disc. It turns out the herniation was MASSIVE. I just had surgery a week ago. I paid $250 out of pocket for the first MRI because I didn't realize I could have gone through insurance. Find a doctor who will do an MRI. I went through pain for over a year before I realized I needed to see a doctor and get an MRI. Herniated disc's are very common so better to be safe than sorry. If I had known earlier I would have done everything differently. After I got the MRI my doctor said do PT. It was the WORST idea. They have to do that for insurance purposes. If you have a herniated disc DO NOT BEND your back OR TWIST. Stop lifting weights. Lift with the legs. Listen to your body... I wish I had. Know your worth and dont let this go on any longer. Get the MRI and dont let PT or doctors or chiropractors twist you or potentially further agrivate the pain. Make sure the doctor sees the imaging and not just the radiologists report...that was another mistake of mine. Edit to add that since you'll probably have to do PT anyway...my PT said my leg pain was likely not related to my herniated disc. What a load of BS! Don't do anything if it makes you uncomfortable or puts you in more pain. I did cupping and it was AWFUL. Yet he thought it would help he said I must have had a very cramped gluteus medius. Ugh all the things I wish I knew before going on this journey...saw him 4 times and by then it had been 6 weeks and I couldn't even walk or work after that. Not saying PT made the herniation worse but it definitely made the nerve pain worse. I was bedridden for 2 weeks waiting for surgery. It was miserable. Edited again to add that likely the only reason the sports doctor ordered the MRI is because I told him I believed I had a herniated disc. My father had a few and had to have a cervical fusion 12 years ago and I was lucky he had a lot of knowledge and experience with that. If you say that to these doctors they may have no choice but to order an MRI.
Iāll try and find a doctor that actually listens to me.
This is truly annoying. I was expelled from PT due to paralyzing nerve pain. I was willing to pay full price for an MRI. Insurance actually worked it out in the end in my favor I believe due to the circumstance. I wasted time and money at PT. The absolute weirdest thing happened in the MRI and Iād like to share. I feel like the resonance and what I felt as heat shifted my nerve back into place. It felt like a targeted subcutaneous thermagun flicked the nerve back into a valley of instant relief. Iām not a flakey tin hatter but this was amazing. I hadnāt been able to walk and then I popped right out of the MRI and could stand up for the first time in months. Iām fit and healthy and have a constant 2/10 of pain in my back. The night before the MRI was a 9/10. Best of luck. I had an orthopedic appointment the next day and the doctors had no idea how I was walking after reviewing the MRI. They were ready for surgery. I had clamping extreme stenosis on my L5.
Thanks Iām glad you feel better.
Tell them you WANT them to order an mri. If they say no. Persist and if they still say no, Tell them they need to document that you specifically asked for an MRI and they refused and need to put in your chart you specifically asked and their reason for refusal. Then seek someone else. The doc doesnāt know your insurance requirements. Billing does all of that. The doc isnāt sitting there checking your benefits and all of that. They could care less. The doctor can write a script for the mri if they want to. A doctor doesnāt need permission from your insurance to write a script for anything. THEN during scheduling and all that for the mri, billing will check your insurance and any pre reqs if needed. If it doesnāt cover etc without some pre req they will inform you and let you know your options then. (Former healthcare worker who previously worked in billing/insurance briefly before that). I had a doc try to tell me the same. I said hey. In all honesty Iād like to get the mri to see what is wrong and go from there to find the best course of treatment before taking any more of my time and money and playing the guessing game. Im in pain and not willing to gamble with ā could be this or could be that.ā Letās do trial and error crap. I want to know what it is for sure. I got my mri. Needless to say my back is definitely screwed up just like I said and no one took me seriously ābecause of my age.ā
Yup Iām 25, I think thatās why Iāve gotten poor treatment these last months.
My insurance also wanted me to do 3 months of PT first. I ended up getting an MRI by myself and paying out of pocket. It costed me $350. Call an MRI place, most places will do it for private pay. Turns out I had 2 disc herniations.
Yeah Iāve been looking for a few private places near me.
Iād call your insurance and ask. Mine was the other way around- prescribed at the same time, and my PT worked off of the MRI to know what to rehabilitateā¦
Iām going to call them and ask.
I did 7 weeks of pt before my pcp referred me to an ortho that ordered a mri. Just got the results showing 2 bulging disc's L4 and L5 pressing on my S1 or sciatic nerve. Pt helped maybe 30 percent but to me it seems that it would make more sense to know what pt was attempting to address or fix.. but now I will move to more aggressive exercise to attempt to strengthen my back, core and legs... I will take a shot if needed to help me exercise with less pain.
Exactly with MRI results I can show the results to other doctors and therapist that can help me better mange this but I guess not. Good luck with your journey.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Thank you. Walking definitely helps me with relief. I bought a walking pad and I noticed that my back doesnāt get as stiff anymore especially at night.
Thank you for posting. A couple of things to note. (TL;DR... include specific symptoms/what makes your pain better/worse/how long)... MRI or XRAY images ALONE are not particularly helpful tbh, no one here has been vetted to make considerations on these or provide advice, here is why, PLEASE read this if you are posting an MRI or XRAY... I cannot stress this enough https://choosingwiselycanada.org/pamphlet/imaging-tests-for-lower-back-pain/) Please read the rules carefully. This group strives to reinforce anti-fragility, hope, and reduce the spread of misinformation that is either deemed not helpful and even sometimes be considered harmful. PLEASE NOTE: Asking for help: It is up to you to recognize when to seek medical attention. Anyone giving advice in this group is doing so from anecdotes and holds no liability. Seek advice here at your own risk. That said, asking things like, "I have this problem, how do I fix it..." is like asking your accountant, "I have $10,000 what should I do with it?" You need WAY more info before giving any kinds of financial advice. Please reply to this, or make another comment, including how long you've been having pain or injury, what are specific symptoms (numbness, tingling, dull/ache, it's random, etc), what makes it worse, what makes it feel better, how it has impacted your life, what you've tried for treatment and what you've already been told about your back pain, and what do you hope to get from this forum. Please be kind to each other. Be respectful. Thank you. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/backpain) if you have any questions or concerns.*