What has been your experience with your health insurance covering follow up MRI's?

I'm wondering how often you can get a spine MRI and have it covered by insurance? I realize it depends on the insurance but I'm curious about people's experiences. (In my experience for the same body part it needs to be a year apart unless a new injury occured, not to follow up on the same injury healing.)

I've had a fusion C4-C7 in 2015. I have herniations in my C3-C4, C7-T1, T2-T3, L5-S1. My father hit me in my thoracic spine hard twice and it whipped my head back as far as it could go. This happened 3 weeks ago and I'm still having radiating pain and weakness in my arms. Before the hit, my C3-C4 was touching my spinal cord but not compressing it so they left it alone. I'm somewhat afraid to get an MRI and find new cord compression and need another fusion. I'd like to wait for about 2 months and see if I can heal whatever has happened. 

(At the same time, if I wait, I have on my record an injury. If anyone has ever had a motor vehicle accident go to deposition, the other side uses every headache you've ever reported as something to blame your spinal injury on. Yesterday, I was going to make a left at a green light when a car came speeding towards my driver's side door and slammed on its brakes. I was almost side hit by an SUV going through a red light. Thank God nothing happened but if it did I could have trouble with my bills even when the other driver is at fault.)

I'm worried about 2 scenarios. Mostly, if I get an MRI and it shows cord compression they will want to go ahead with the surgery. If I wait 2 months to get the MRI's maybe I can heal it.

• If I get the MRI now does insurance cover you getting another MRI so soon to see if it healed? Would they do it in 6 months to see if it's better?

I appreciate anyone's insight and experience.



  • I had surgery on mid February and insurance would not approve another MRI 2 weeks after, though I was in as much pain as the day after surgery.  My surgeon told me to go to emergency I’m order to get it done on an emergency basis.  I had another in July which insurance did approve.  I should not I had CT scans each time also.  Good luck

  • L4_L5LL4_L5 Posts: 1,275
    edited 01/07/2020 - 4:38 PM

    I have a back injury from work and workman’s comp. allows unlimited lumbar MRI’s with no prior authorization needed. So I’m very fortunate in that respect. On average I have one lumbar MRI every 12-24 months to see how my discs are doing.

    I would call the 1-800 member services telephone number on the back of your insurance card since only they can answer your question.


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  • Thank you, @Joel1Q & @L4_L5. I could call my insurance but each time I do they seem reluctant to tell me anything in case they misquote until the actual order goes through. I remember wanting another MRI before my surgery because I so didn't want a 3 level fusion but my symptoms were worse than ever and I knew it had gone too far by then.

    I think I'll hope that the next 2 months brings improvement before I get the MRI's because I think they only let the same body part once a year unless some new issue happened.

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