Seeking Advice on Insurance MRI Denial for Back Pain Treatment: My Journey and What Are My Options?

Hi! I am seeking for advise. Ihave been dealing with debilitating lower back pain since June. I started working with a chiropractor with no back pain relief.
The pain gets worse at night and from June until August I was not able to sleep.
I went to see my primary care doctor in July. She prescribed medications to help with inflammation, but nothing helped alĂ­viate the pain. At that point, I decided that I needed to see a specialist. After a month-long wait, I finally had an appointment with an orthopedist in August (this is 2.5 months after presenting symptoms). The orthopedist ordered an MRI and recommended Physical Therapy.
I'm sharing this detailed account because my insurance company has denied coverage for the MRI. The denial occurred not only after the initial claim submission but also after a subsequent appeal that my doctor's office submitted on my behalf.

The letter from the insurance company cited three reasons for the denial:

Your pain has not improved after six weeks of treatment Treatment should include medications and other forms of therapy. These need to include home exercises or physical therapy Your doctor should use the test results to decide on the best plan for you. The notes do not show that you meet all the required criteria.
I believe I met every single one of their criteria.

I am reaching out to inquire if any of you have successfully navigated similar appeal processes or have any valuable advice to offer.

I am still reliant on multiple medications to manage the pain and help me sleep, in addition to diligently attending physical therapy sessions (the therapist has recommended 12 sessions, I have completed 7).

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Do you know what are my options now?

submitted by /u/kakekikoku-AE
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