I can relate to the problems with insurance. I spent many hours on the phone trying to get the PET scan my doctor ordered. I learned a few things that might help you:
1. They have the standard protocols that they will not compromise. Go with the flow and have the tests they WILL cover first. This can be frustrating and a waste of money but they won't budge with it - I learned.
2. they have internal advocates that can help - request a CASE MANAGER. This person helped me by advocating WITHIN the system. Get to know this person and ask them how you can get what you need.
3. PERSIST. I read that after a procedure is denied, that most insurances finally give in with persistence. Follow the appeal process and keep appealing - DON'T QUIT!!!!
4. become educated. Use their system to your advantage. I researched the insurance company's own criteria for PET scans and used this in my argument for it.
5. enlist the help from your doctor. They know how to use the system and sometimes they will order the same test another way. Tell your Dr. of your problem and ask help.
6. Keep good records.
7. Try to stay calm during this. They are bureaucracies and go VERY slowly. Accepting and expecting this will lower your stress and anxiety.
8. If all else fails - A colleague of mine used this one, not me. Essentially it's a statement to them that if you die because of their failure to provide the ordered test, your heirs will sue them!! It worked for her!
Yes, I finally got my PET scan. And you will get your tests too. Unfortunately, I will probably have to repeat this next time a PET is ordered.
Hang tough, Ladies. Mary Ann
