• Who has had insurance denial of PET Scans, or other procedures? What was the reason?

    Asked by GregP_WN on Saturday, December 14, 2019

    Who has had insurance denial of PET Scans, or other procedures? What was the reason?

    These days It seems to be a harder and harder task to get insurance to pay for the things that were paid with no problem a few years ago. What types of procedures have you been denied for?

    6 Answers from the Community

    6 answers
    • BobbyZ's Avatar

      I have had to wait as much as 2 months to get approval for a procedure. It's a good thing it wasn't a life or death deal.

      about 1 year ago
    • Bengal's Avatar

      I had an MRI and my entire radiation treatments denied AFTER these procedures had already been done with "pre-approval" (which apparently means absolutely nothing; read the fine print). I was very, very lucky however. My hospital took the appeal procedure completely out of my hands, told me not to give it another thought. That was such a huge relief. I did continue to worry about it in the back of my mind but eventually got notification that it had been settled. I feel so bad for anyone who is going through the trauma of diagnosis and treatment and then gets a payment denial thrown at them. NOT something anyone needs to be dealing with when they are sick, scared and physically depleted.

      about 1 year ago
    • Berton's Avatar

      I was denied a pet scan after my treatments was over with the excuse that they do not pay for routine pet scans. My oncologist even got on the phone with them, but agreed to just an mri would be efficient. When i mention it to my other doctors as to why it was denied. Their responses was the same, since when has a pet scan routine?

      about 1 year ago
    • po18guy's Avatar

      I was denied an autologous stem cell transplant, probably a combination of cost ($350-$500K), as well as the fact that I was in complete response at the time. However, they did allow an allogeneic stem cell transplant, which was closer to $500K.

      about 1 year ago
    • debster's Avatar

      Greg do hope that you are getting insurance approvals you need...the system is so broken! I could not get approval for my year 5 SCAN....so to this day other insurance companies will not consider me "cancer-free". My oncologist was a huge advocate for me with the insurance company and didn't take no - going to higher up and higher up. In the end, I lost. They said that nothing suggested I needed another annual scan. They would rather wait to do treatment than to be preventative. Sad story about our health care system. BTW I was private pay in the best of the best insurances - paying over $15K a year for the premiums. Ugh.

      about 1 year ago
    • bethseptember's Avatar

      My oncologist had to fight with the insurance medical director for my 2nd PET scan. My case manager was on conference call at the time. The case manager stated she has never been part of such a "heated" conversation with 2 physicians.
      My oncologist won. The insurance physician stated, "Have the XXX PET scan. "
      XXX was sore loser.
      Definitive proof I was free of mets. Bless my oncologist for the fight in her.

      about 1 year ago

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