About a month ago a patient required an MRI of her lower back to help us help her. Our staff called her insurance company, Aetna, who said no precertification was required and a script was written for the test. A week later, University Radiology called us to say precertification was required. Our staff called Aetna, this time on a three way call to University Radiology to again tell us precertification was not required. Again, another person from University insisted precertification was required and it was now two weeks later. Apparently, they were logging into another company, Evicore, a middle man for the insurer whose web site was saying she required recertification. The patients husband decided to call another facility who did the same thing. We were at three weeks past my referral at this point. I told her husband that in network, they would charge about $800 under the negotiated fee vs $450 if you elected to pay cash, something that makes no sense but is routinely done. Meanwhile, it turned out the patient had given them a blue cross blue shield card which was her old insurance. This plan required Evicore to precert. The patient paid cash and 4 weeks later had her MRI which gave us the medical necessity for a specialist referral for her spinal issue. It should never take four weeks to get an MRI and two middlemen, the insurance and Evicore were part of the problem. Expansion of Medicare or a public option to the current system can eliminate this altogether. What are we waiting for?