Ambulatory EEG before meeting Neuro?

[StaceyCeCe]

Hi everyone,

Here is the first of many questions I'm sure I'll have for you:

Is it normal for a neurologist to order an Ambulatory EEG before meeting the patient?

When I "fainted" in the car last Wednesday, I called my doctor (Internal Medicine) and informed him as he has been the one I've been seeing for everything. He told me he would speak to his neurologist. He called me back and said his neurologist was ordering an ambulatory (at that time, I had no idea what that was). The neurologist's office then called me to confirm that they would be ordering an ambulatory for me and the office that will do the ambulatory will call to schedule it. The office, Neurotech, then called me to confirm and schedule an appointment.

Well, they are the ones that then called the following day to say that my insurance has denied the authorization because it's not a "medical necessity".

Ok.

So, I figured I would just schedule an appointment with the neurologist to talk to him personally and tell him everything that has happened in the last four weeks. Well, that wasn't easy. He only takes appointments by referrals. I had to call my regular doctor (who is on vacation until the day of my scheduled ambulatory) to ask for a referral. Of course, I had to leave a message with the on-call doctor who is helping out my doctor while on vacation. I got the referral and went to schedule an appointment.

The earliest the neurologist can see me is 5 days after my scheduled ambulatory. I explained the whole insurance thing and the assistant didn't know what I should do. I asked if I should wait to have the ambulatory until after I see the neurologist. She said to call my regular doctor and see what he says.

(sigh)

I guess I am just wondering if it's normal for a neurologist, upon reviewing a "normal" eeg scan, to order a 48 hour ambulatory without ever meeting with the patient.

Right now, my husband is thinking we should postpone the ambulatory until after we meet the neurologist. I understand where he is coming from: he doesn't want me to assume that I am experiencing seizures and have epilepsy until I see a neurologist. He's concerned about the expense if the insurance doesn't pay for it and the scans come back normal.

Thoughts?

Thank you!

Stacey

[Nakamova]

It seems like there are two different issues here:
1. Whether you'll have to pay for a "medically uneccessary" ambulatory EEG
2. Whether the neurologist is jumping the gun in scheduling the EEG in the first place.
Your neurologist may well have his reasons, but since he hasn't made them clear to you, and isn't available to answer your questions, then I agree that postponing the EEG is the way to go. The insurance issue seals the deal.

You and your neurologist may well find that the ambulatory EEG is helpful to record seizures that didn't show up on the initial EEG, but if there's no absolute rush to have it than it can wait until after he's made his reasoning clearer.

[epileric]

You don't know what the doctor said to the neurologist. He might have decided it based on that.

Personally I think it's great that the doctor can see you & actually know more about your neurological situation. I had one neurologist that sent me for a battery of tests (including EEG) over 3 days before I even met him. It made me feel that he was serious & wanted to know what he was dealing with. I was extremely impressed since he was the one who after 39 years actually found the cause of my seizures. To this day I think he's the best neurologist I've had.

[Endless]

Hi, Stacy,

My epileptologist had two EEG test results, MRI, CAT scan, etc. before I ever went in to see him. My primary care physician had ordered these, and my epileptologist needed them to be able to even begin to talk with me about the subject . The more info you can go in with, the better.

After seeing me he got me on meds and then ordered a 5-day video EEG (where they took me off the meds cold turkey, yikes!) and an ambulatory EEG.

If your neurologist ordered the test, try having your PCP order it and see if it makes a difference to your insurance company. Also call your insurance company and ask them what their criteria is for "medically necessary." They may require a preliminary diagnosis of seizures. (It may nor may not be identified as epilepsy, and they may not care which doc makes the diagnosis - your primary care doc or your neurologist) Once you know what their requirement is, you can communicate this to your doctor's office so they can fulfill it and get the test ordered.

I'd love it if they doctor's offices always jump through all the hoops to get insurance in line, but they don't. I've had to get in there and work things out several times.

From reading the posts in here you'll see that normal EEGs happen quite often - at least 40% of the time. Especially in partial seizures in the temporal lobes, or frontal lobe seizures. An ambulatory EEG gives a better picture, an in-patient Video EEG gives an even better picture. So, if your EEGs come back negative it doesn't necessarily mean you don't have epilepsy.

Keep on plugging with that insurance company. And if you want to know why the neurologist ordered the test, just call in and ask. His assistant will take the question and get the answer and call you back with it, no worries.

[StaceyCeCe]

Well, I just got off the phone with the lovely woman at Blue Cross/Blue Shield in Florida. She said that my doctor needs to have a "pre-determination" before they can say whether or not I'm eligible for the coverage.

I guess I'm just going to wait until after I see the neurologist on the 30th.

How frustrating.