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What would you do?

ratface's picture
ratface
Posts: 1232
Joined: Aug 2009

So you are meeting with your Oncologist four years out with zero evidence of cancer. You have had lung nodules detected in the previous four years but they remain unchanged. Your Insurance company denied your last scans because you were asypmtomatic.  Your Oncologist suggests you have a recurrent cough that is creating anxiety. Do you contact the insurance company and request permission for a new scan, (Chest only this time) as required per policy. Do you just choose not to go through the anguish of denial again? Or, big Or, here, do you follow procedure and let the chips fall where they may? I was fine going into this appointment without the scan but now the request  of the oncologist raises issues, mainly the why issue.  He said it was the right thing to do. Do you agree? This cancer stuff sure is complicated.

phrannie51's picture
phrannie51
Posts: 3628
Joined: Mar 2012

it would seem to me that a "reoccuring cough" would take you out of the asymptomatic mode, and put you where the insurance company wants you for a scan....after having HNC, it would seem (to me) that you DO have something that needs to be checked.

Around these parts I was told (basically).....if I was worried about my lungs, I could always do a walk in at the imaging center for a chest xray....uh...an xray???  Why the hell not scan my chest when you do my neck?  And when will I ever have another PET scan??  They're being stingy with my insurance companies money, and dangling my good health (and warm fuzzies) in the wind....

Go for the requesting of a scan......and....don't get too uptight.....the Onc is taking care of you, and the recurrent cough is probably absolutely nothing....a new allergy or something on that order.

p

fishmanpa's picture
fishmanpa
Posts: 1105
Joined: Jan 2013

Hi Ratface,

I just posed the question about scans to my RO today and was told no further scans were planned. But then I don't have lung nodules. He said maybe a CAT scan but recommended a yearly chest xray that my PCP can order. I'll be scoped evey three months for the next two years but they were confident they got the beast. 

From what you wrote, it seems the request is more for your anxiety than it is for suspicion of an issue based on the nodules remaining stable. If your doc is recommending it then why would your insurance refuse? Might be worth a call. Worst case they say no again and it comes out of your pocket if you choose to pursue it.

Positive thoughts and prayers.

"T"

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

You already know the right answer, you just don't want to admit it....

Get the scan, let the MD's be the experts....

Always be pro-active, never re-active....

Just Do It....

Thoughts and prayers and in your corner..

John

jim and i's picture
jim and i
Posts: 1569
Joined: May 2011

I agree with John, get that scan. Ask your oncologist to call the insurance. Jim's ENT called our insurance company for the PET before biopsy because his cancer was so advanced. It reslly irritates me when the insurance company tries to circumvent the doctor. If you call and they say no, ask for their superior and keep asking for each persons superior until you get a yes. Praying for you.

Debbie

jim and i's picture
jim and i
Posts: 1569
Joined: May 2011

I agree with John, get that scan. Ask your oncologist to call the insurance. Jim's ENT called our insurance company for the PET before biopsy because his cancer was so advanced. It reslly irritates me when the insurance company tries to circumvent the doctor. If you call and they say no, ask for their superior and keep asking for each persons superior until you get a yes. Praying for you.

Debbie

CivilMatt's picture
CivilMatt
Posts: 2866
Joined: May 2012

Ratface,

The cough is reason enough (along with other issues) to generate a scan.  What you can’t see can hurt you? After all this is why they do scans.

Matt

TracyLynn72's picture
TracyLynn72
Posts: 648
Joined: May 2013

with the others.  Get the scan.  I've done all of my surgeries, treatments, tests, appointments with NO insurance, and all of the medical facilities have been more than willing to work with us.  If you'd have to pay out of pocket, don't let that deter you from having it done.  It will all work itself out. 

D Lewis's picture
D Lewis
Posts: 1523
Joined: Jan 2010

I've got the lung nodules.  I was able to kick and scream enough to get permission for a chest CT, at the three-year mark.  I was told that from here on out, lung X-Rays would be enough to further track the nodules.  If they see any changes, I would then qualify for another chest CT.  Otherwise, X-Rays it will be.

Deb

luv4lacrosse's picture
luv4lacrosse
Posts: 1377
Joined: Jul 2010

Rat, push and force the insurance for the tests. I have had the same fight. I told my insurance co. As I call them "mutual of do we ****em and how" pay a little now for the preventative, or pay up the ass later. I know you, we are old school, get the answer and fight the good fight. 

Sorry for the rant, got good news on my CT this past Friday, and am pumped.

Best

Mike

Tim6003's picture
Tim6003
Posts: 1490
Joined: Nov 2011

Get your doctor to request the scan from the insurance company....then get a 2nd opinion from another doctor (who will most likely do the same) and have the 2nd doctor OR you, ALSO present to the insurance company a request for a scan.  So let me see, 2 seperate docs saying a scan is needed, insurance company denying scan,....I would think the insurance company would cave and if not, appeal with the same 2 docs request and make a note of your history of nodes (in case the docs do not) ...that oughta do it :)

 

Keep us posted....

 

Tim

Duggie88's picture
Duggie88
Posts: 528
Joined: Feb 2010

I agree with the rest. Being a Trustet in a health fund I hear appeals quite often and will overturn the ruling. Get that second opinion it will certaily help.

My $.02

     Jeff

Ladylacy
Posts: 464
Joined: Apr 2012

Get the scan and fight with your insurance company for it.  Too many don't fight.  I know my husband had the nodules in his right lung and they showed each PET/CT scan for the last 2 years but no growth was noted.  Then in February when they did the PET/CT scan they showed growth, albiet very small.  So a needle biopsy was ordered and it turned out that his 2nd primary has spread to his right lung.  He didn't have a cough though he had pain in his shoulder and upper back and the doctors couldn't explain why until they did the PET/CT scan. 

I have had to appeal many things that were denied and have always won them.  Insurance companies don't expect people to appeal and fight for what they need.  Your doctor can help with that.  Funny thing is that doctors and hospitals only get a small percentage of what they charge so I don't understand why so many things are denied.  And for all those that think because you are on Medicare/Medicare Advantage Programs you have no problems, that in itself is the biggest laugh of all.

Sharon

debbiejeanne's picture
debbiejeanne
Posts: 2293
Joined: Jan 2010

rat, i agree w/all the others, GET THE SCAN.  if ins won't pay 4 it, sometimes the facility will write it off and u don't have to pay anything.  either way u need the scan so get'r done.  let us know how it turns out.  will b praying.

dj

katenorwood
Posts: 1812
Joined: May 2012

the clinic does the pre-authorization......sometimes it takes a bit, but it's their job not yours.  Put a call into your onc's nurse.....and she will get the ball rolling.  I too have the lung noduals.....and so far haven't had an issue with the insurance company.  But I'm only 19 months out.  An x-ray will show them.....but an MRI/CT will give the drs. a better idea of growth or no growth.  I'm keeping you in my thoughts for a resolution on this one, and only good outcomes.  Hugs sent !  Katie

peggylulu's picture
peggylulu
Posts: 367
Joined: Dec 2012

with everyone else ! have your Doctors office call the Ins. co . That should do it but if not pay for it .

Peggy

ratface's picture
ratface
Posts: 1232
Joined: Aug 2009

I'm really frustrated with the whole system as it just creates more anxiety. My insurance carrier, BCBS of Il. makes me pre-certify by phone and they have automatically denied me everytime past the two year mark. They deny administratively within 7 days if paperwork isn't submited. Try and get anything submitted in seven days.  I know the nurses by first name and they submit the documentation. I always appeal and won the first couple of times but last time around I lost the second tier appeal. It's a huge hassle and every phone call and denial letter just inflames me. It borders on criminal.  The second "primary" argument is something I hadn't considered. I guess I can go another round with them. They wear your ass out. Thanks guys.

Greg53's picture
Greg53
Posts: 830
Joined: Apr 2010

RF,

 

Minimizing the number of scans post tx certainly seems to be the gameplan from the insurance companies these days.  Seems to me that it was no issue to get CT and alternating PETs fairly frequently just a year or two back.  That does not seem to be the case anymore, including yours truly.  Was originally scheduled for the alternating scenario thru year 5.  Was told recently that it would change to only be CT’s; no more PETs.  Don’t know if they’re trying save $$ or if they think long term rates for us is improving??  BUT in your case, I agree with the rest of the gang, I’d go for it.  I understand the frustration with BCBS of ILL also.  Even though I’m in Missouri, my company is HQ’d in ILL and that’s who I have (BCBS).  It’s a fight with them everytime I get a scan.  Luckily, the person who handles this at my ONC’s office  is persistent and knows how to play the game and gets it accomplished for me.  Good luck with it!

 

Hope everything else is going well Sir!

 

Greg

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

That explains the grief your insurance company is giving you.....

Their last two initials are BS....

JG

hwt's picture
hwt
Posts: 1848
Joined: Jun 2012

Try filing a complaint with IL Dept. of Insurance if your Oncologist orders and they deny.

cureitall66's picture
cureitall66
Posts: 844
Joined: Aug 2012

Ratface,

As you know my loved one was dx a year ago and has been out of tx now for 6 months. We were told "No scans"...unless there was an issue that came up that was in "question"....we only get yearly chest xrays.....this had nothing to do with the health insurance (which is BCBS of MI). This is coming as, what I may say, a new protocol because they feel the more scans (injecting nucleur dye) he has more of a chance of recurrence. I do not know where/when they decided to start doing this. But, I'm seeing more and more Newbies on here getting some of the same information. But, in your case there is a "question" about your coughing....so get the SCAN!

I think you will find that insurance companies will be a bit easier to deal with in getting these scans, if not now, very soon, as the push for PREVENTATIVE measures are being the new requirements under OBAMA CARE. I've noticed in my own care recently that BCBS is covering more of my preventative care that I get done yearly with no question....and never did that before. Also, as a self paying insured I'm getting information mailed to me most recently about how my insurance will change under the new law and there is a list of preventaive care that was never available under my plan before. 

Anyways, that's my two cents for what it's worth. I just think you should go for the scan....it will also give you peace of mind.

Take care,

~C 

MICH4EL's picture
MICH4EL
Posts: 73
Joined: Mar 2013

i agree with what has been suggested.  The cough is a system. Ask your doc to request ins approval based on cough.  

TracyLynn72's picture
TracyLynn72
Posts: 648
Joined: May 2013

Just to give you an example (as a worst case scenario), I had a CT scan that was head/neck/chest and the hospital billed me $8000.  I told them I had no insurance and they dropped it to $4200.  I started making payments of $50/month and they dropped the balance again to $2000.  I'll have that paid off soon.  

 

BCBS should help you.  Insurance is so annoying at times, but hopefully we can get some this year.  It's tough not to have it too. 

Hondo's picture
Hondo
Posts: 5656
Joined: Apr 2009

I agree you need to do what you need to do, get the scan, sometimes the chips fall too late. I know none of us like doing them but it is a part of our lives. Call the insurance or what I did one time I had my doctor call and write them explaining why he is ordering a new scan…

 

Hondo

Noellesmom
Posts: 1279
Joined: Aug 2010

present it to your insurance company, be prepared to push for the scan but praying you won't need to.

 

Let us hear what you find out from the scan.

 

staceya's picture
staceya
Posts: 701
Joined: Jan 2010

Your Insurance company denied your last scans because you were asypmtomatic.

Well now with a cough and nodules you are no longer asymptomatic.
As a nurse I make prior authorization calls ALL the time. It does take an immense amount of patience. One time, the insurance company was giving me a real hard time. They asked several times " What kind of doctor is requesting this?" I finally said, he is a voodoo doctor and maybe we will put a spell on you if you reject it.

Fighting the cancer is hard enough with fighting the insurance companies.

Thinking of you.

Stacey

staceya's picture
staceya
Posts: 701
Joined: Jan 2010

Your Insurance company denied your last scans because you were asypmtomatic.

Well now with a cough and nodules you are no longer asymptomatic.
As a nurse I make prior authorization calls ALL the time. It does take an immense amount of patience. One time, the insurance company was giving me a real hard time. They asked several times " What kind of doctor is requesting this?" I finally said, he is a voodoo doctor and maybe we will put a spell on you if you reject it.

Fighting the cancer is hard enough without fighting the insurance companies.

Thinking of you.

Stacey

Viilik70's picture
Viilik70
Posts: 56
Joined: May 2012

I agree with John because you don't want to live your life with regrets from doing nothing. Do something : ) God bless...

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