Knew It Was Coming -- Insurance Companies Suck

jthornsbury

Friends,

Knew it was coming and it finally happened...even thought NCI and MD Anderson recommend specific scheudle for followup scans my insurance company has denied my next scan (two year) because it is not "medically necessary"!! Have others had issues...thanks!

 

Jon

hwt

Me too

BCBS had been great about my PETS, CTs and MRIs. Suddenly they denied my last PET saying unless something specifically indicated a problem they would not aprove. DR ar Mayo personally called them and they denied telling him to do CT. Still battling because they said CT didn't have preauth. 

TracyLynn72

No insurance

I had no insurance during my cancer battle and had to fight to get assistance.  Now, I have insurance (and it's crappy) and it only pays a few dollars of each of my visits, xrays, follow ups, etc.  I'm usually stuck doing a payment plan.  

ratface

TracyLynn72 said:

No insurance

I had no insurance during my cancer battle and had to fight to get assistance.  Now, I have insurance (and it's crappy) and it only pays a few dollars of each of my visits, xrays, follow ups, etc.  I'm usually stuck doing a payment plan.  

It's Normal

Hi Jon

 

Yes it's happened to me repeatedly. Don't let it frustrate you too much. You have to argue from a strong position and can almost always win an appeal. I won my last three appeals. They use the Federal guidelines which recommend only an xray for this type of cancer if no symptoms are present. First you need to call and open an appeal. They have to by law submit your case to an independent ENT and get his opionion on the decision. The independent ENT in the absence of any new facts will decide in their favor. You and your doctor have to submit documentation showing that there are symptoms which warrant the scans.  This is typically trouble swallowing or a persistent cough or an unexplained pain in the neck from the insurance company. Generally speaking it is a PITA for them to go thru the appeal process and many times just openning an appeal is enough. It gets progressively more difficult and you and your doctors have to get more creative as the years go by. All that said CT scans are harmfull and you are probably better off without them if you have zero symptoms. The doctors are in a "Better safe than sorry mode" and the insurance companies are in a "Do what is minimally necessary" mode. " You have to find a comfortable middle ground that is in your best interest.  Call them, be polite, ask direct questions, get a detailed explanation of the guidelines they are using and the how their appeal process works along with time frames. BCBS automatically denies a request if they cannot contact someone at your doctors office. They typically deny, " pending addtional documentation."  Learn the rules and then use them against them. If you need the scans you can win any appeal with your doctor and most importantly the doctors nurse on your side. The nurse is the one who will send all the documentation. Grease the wheels, Chocolate works well here!

Guzzle

ratface said:

It's Normal

Hi Jon

 

Yes it's happened to me repeatedly. Don't let it frustrate you too much. You have to argue from a strong position and can almost always win an appeal. I won my last three appeals. They use the Federal guidelines which recommend only an xray for this type of cancer if no symptoms are present. First you need to call and open an appeal. They have to by law submit your case to an independent ENT and get his opionion on the decision. The independent ENT in the absence of any new facts will decide in their favor. You and your doctor have to submit documentation showing that there are symptoms which warrant the scans.  This is typically trouble swallowing or a persistent cough or an unexplained pain in the neck from the insurance company. Generally speaking it is a PITA for them to go thru the appeal process and many times just openning an appeal is enough. It gets progressively more difficult and you and your doctors have to get more creative as the years go by. All that said CT scans are harmfull and you are probably better off without them if you have zero symptoms. The doctors are in a "Better safe than sorry mode" and the insurance companies are in a "Do what is minimally necessary" mode. " You have to find a comfortable middle ground that is in your best interest.  Call them, be polite, ask direct questions, get a detailed explanation of the guidelines they are using and the how their appeal process works along with time frames. BCBS automatically denies a request if they cannot contact someone at your doctors office. They typically deny, " pending addtional documentation."  Learn the rules and then use them against them. If you need the scans you can win any appeal with your doctor and most importantly the doctors nurse on your side. The nurse is the one who will send all the documentation. Grease the wheels, Chocolate works well here!

Business
Rick you should go into business advocating on behalf of patients mate!

Hondo

insurance

I think we are all in the same boat when it comes to insurance, I now have to get my primary doctor to schedule an appointment with my ENT who I been seeing for the last 7 years every 3 months. So instead of just going to see my ENT I have to see my primary dr first every time that cost twice as much, but I guess they have not figured that out yet.

 

Tim