• Insurance denial

    Asked by Jacrnich on Monday, September 19, 2016

    Insurance denial

    I have stage 3 lung cancer and have been denied a PET scan....

    12 Answers from the Community

    12 answers
    • lh25's Avatar
      lh25

      It sounds like your doctor thinks you need one? Look into the appeal process with your insurer.

      almost 3 years ago
    • barryboomer's Avatar
      barryboomer

      It happens often as they are too expensive....Heartless Bastards are the Insurance Companies.

      almost 3 years ago
    • Ejourneys' Avatar
    • LiveWithCancer's Avatar
      LiveWithCancer

      I have heard that you are limited to a certain number of PET scans over a lifetime. I don't know if that's true and it would no doubt depend on your insurance.

      My oncologist doesn't trust PET scans. I have requested one in the past because sometimes the radiologist calls my tumors scars. I wanted a PET to see of they are scars. He said no. He says there are too many false positives.

      almost 3 years ago
    • geekling's Avatar
      geekling

      Go to the people tab and look up BuckeyeShelby.

      She works in the insurance industry.

      If she has time, Im sure she will guide you.

      If not, plunk her name into the questions tab and click on search. She is likely getting tired of repeating herself so you can simply see how she has answered similar questions beforefrom other and use the answers as a guide.

      Best wishes.

      almost 3 years ago
    • SandiA's Avatar
      SandiA

      I was denied twice and was told my doctor needed to call and do a peer to peer conference call. He called, I felt bad because they had him on the phone for a while but still said no. Not sure what he said to them but a few hours later they called back and said it was approved. I hope it works out.

      almost 3 years ago
    • GregP_WN's Avatar
      GregP_WN

      I was in the insurance business years ago, for around 10 yeas. Boy have things changed! Back then, you went to the hospital, had your gig done, called me with your hospital bill, we came and filled out a form, sent it and your bills in, and in a few weeks the bills were paid. Not anymore!! Now the insurance companies have about as many people working to figure out how not to pay a claim as they do people trying to sell policies. It really ticks me off. It's not all the insurance companies fault, it's the whole system, patients trying to XXX the insurance company, Doctors charging too much, or trying to scr3w the insurance company, or medicare, hospitals charging twice what they should, just so maybe they get what they wanted to charge in the first place. My first diagnosis, covering almost a year, several stays in the hospital, one major surgery, two port surgeries and untold scans, total for the whole deal.....less that 250K. 1988. Now, one night in the hospital for an outpatient tonsil removal......25K

      almost 3 years ago
    • dhtdiver's Avatar
      dhtdiver

      If it was ordered for purely follow up purposes, it would be denied. A PET scan is for diagnostic purposes. Once your scans are clear a PET scan is unnecessary and exposes you to needless radiation.

      almost 3 years ago
    • BuckeyeShelby's Avatar
      BuckeyeShelby

      I'm the infamous BuckeyeShelby, insurance whisperer... I do work in the industry. Here is my suggestion. Call the insurance carrier. Stay calm; stay polite -- that rep is human and is much more likely to be helpful to you if you are nice to them. Ask how to submit an appeal. I work for a TPA instead of "real insurance" -- if you were calling here, I would advise that you write a letter explaining the situation. Talk to your doctor about getting a letter of medical necessity and copies of your medical records that back the need for the scan. At our company, you would mail that info in to our appeals dept. If you ever call an insurance carrier and they are nasty to you, make sure you get the rep's name and request a supervisor. A rep has NO business getting nasty w/you and I can pretty much assure you that you call was recorded. That's what I do all day -- audit customer service phone calls to make sure our reps are polite and are providing correct info to our patients and doctors. Can't guarantee that the carrier will say yes, but at least you know you'll have done everything in your power to get the scan approved. Good luck! Let me know if I can provide further info.

      almost 3 years ago
    • kalindria's Avatar
      kalindria

      dhtdiver - you may be correct for your area and your insurance but that is not the case everywhere. Kaiser in California routinely gave me PET scans after I was clear to monitor my progress. Here in Washington, they use CT scans which I like less but also picked up my recurrent cancer so I really can't complain.

      I would just be cautious about stating your experiences in Arizona as fact everywhere.

      almost 3 years ago
    • CAS1's Avatar
      CAS1

      every State and Insurance provider is different as is each Oncologist. Mine does not support Pet scans as follow up because too many false positives.

      You have been given great advise..here.

      almost 3 years ago
    • kalindria's Avatar
      kalindria

      I really liked the PET scans because the radiation (or whatever it is) is absorbed by the active cells (including non-cancerous cells os you have to know how to 'read' them) and you can actually SEE the problem areas. The images are actually kind of pretty. My oncologist would always go over each scan with me.

      I did not go to medical school and don't want to cast aspersions, but if a lay person can see and understand what's on the screen, perhaps MDs are just being lazy when they give the excuse of too many false positives.

      And in my experience, a CT scan is nearly as costly as a PET scan so maybe they're just trying to explain away the scan methodology that isn't endorsed by their medical facility?

      almost 3 years ago

    Help the community by answering this question:

    Create an account to post your answer Already have an account? Sign in!

    By using WhatNext, you agree to our User Agreement, and Privacy Policy


    Read and answer more lymphoma, lung cancer questions.  Also, don't forget to check out our Lymphoma, Lung Cancer page.