Insurance telling my doctor I don’t need a prior authorization, while telling me that I do

I have high deductible Ambetter marketplace insurance in Pennsylvania.

My doctor ordered an MRI for me in June. I had the order sent to a radiology facility. The radiology facility asked me for the prior authorization from my insurance. I asked my doctor to get it from Ambetter.

My doctor tried to get it, but the system refused to issue one on the grounds that the prior authorization is NOT necessary for this type of MRI. (The doctor even sent me a screenshot). My doctor called the insurance company, and the company explained on the phone that it isn't necessary for this type of MRI.

Meanwhile, I messaged my insurance company with the CPT code, and they have repeatedly and explicitly, in writing, said that I DO need a prior authorization. It was the same CPT code that the doctor used, so that is consistent.

Then, I called my insurance company, and on the call, they explained to me that I don't need a prior authorization for this CPT code. However, I can't seem to get this in writing.

I called my doctor's hospital patient advocacy line. They couldn't help.

I called the health insurance marketplace in a last ditch effort to get some kind of help. They were not able to help, or even to understand the problem.

My appointment is on Monday, and if I miss it, I have to wait another month. Help! Any ideas?

38 yo, Pennsylvania, gross income ~45k – 50k

submitted by /u/kelly_jelly_belly_
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