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Anyone else having trouble with insurance paying PET or CT scans?

Bobs1wife's picture
Bobs1wife
Posts: 153
Joined: Sep 2010

Throughout the course of treatment starting April 2010, BCBS Nebraska has denied paying for PET scans that our oncologist and surgeon have told us is "protacol" for treatment of EC. Staging PET scan was allowed and one other, then later they denied as being "investigational" and not needed. Head of onclogy dept even talked with them and they still refused on 2nd appeal. Finally agreed to allow CT scan instead of PET after chemo alone before the chemoradiation started.

Our surgeon at Mayo requested a PET scan before surgery, again "protacol" and again it was denied. We were told they finally approved a CT scan, but now the bill comes and BCBS Nebraska has denied paying for a pre-surgery CT scan that was done.

Anyone else having problems with insurance covering their scans?

We were happy to be participating in a clinical trial for EC, and were told that only 4% of adults with cancer participate is trials when offered. We were "released", I call it "kicked out" of the trial because BCBS Nebraska refused to pay for a required PET scan. Trials are very specific. You get your treatment in very specific amounts, time frames, and everything is regulated. We continued on the same plan as the trial, but our results and the findings of our treatment will not be included for the benefit of others to see. Too bad, but we just didn't know of anything we could do about it.

My husband had his surgery Aug 16th. How can we possibly do our follow up if BCBS won't allow the scans at regular intervals like everyone else seems to get? Linda

Hope_Faith
Posts: 164
Joined: Aug 2009

Our insurance will only cover PET scans once a year but will do CT scans every 3 months. If something were to show up on the CT scans, I'm our insurance would cover the PET scan. I've heard PET scans are very, very expensive and so that's why some insurances do not cover them for regular check-ups.
It is frustrating! :(

LivingFaith's picture
LivingFaith
Posts: 84
Joined: Jul 2010

My Dad has BCBS of NE also, and yes they are boogers about approving PET scans. He has had 2. 1 in July when he was first diagnosed and 1 in Sept to check to see if the chemo had worked at all. It took them about 2 weeks to get approval.

My dad is stage IVb so I don't know if that changes the rules. I've worked in Cardiology for years and do know a few "tricks" to get tests approved. We called it creative coding. You need to find out what the approved indications are for a PET scan and then your husband needs to "find" those symptoms and the doctor needs to use those when ordering the test.

I don't know much about Oncology indications so I'm not much help there. The sad thing is insurance companies run healthcare. It's not doctors or hosptials. It's all about the money not patient care. Everyone is so worried about Obama Care, but the thing is healthcare is already being controlled by the very industry that benefits from it. I guess that is a subject for another day.

Deb

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