Gotta love insurance

KTeacher
KTeacher Member Posts: 1,103 Member
in Head and Neck Cancer #1
I have had cancer twice in one year. Radiation twice. Insurance company (Anthem Blue Cross) will not let me get another PET Scan until I am showing symptoms. I asked what the symptoms were to look for (I also have asthma and allergies). This is how I spent my lunch 30 minutes today. I have to agree, Cancer Sucks--so does insurance (but what would we do without it?).

Comments

  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #2
    God fobid
    reason ever enter into this type of decision-making process. Clearly, no one with any familiarity with the disease makes determinations like this You know, even at the level of physician reviewer, sometimes you have an intern trained osteopath (I have nothing against them, but they certainly aren't cancer doctors), making this determination.

    Maybe what they mean is, if your head falls off and rolls around on the floor, then they'd consider letting you get a PET scan. How's that for symptoms:) OTOH, if these are truly the rules you are under, there's an easy way to get around the system. If it ever becomes an issue, we can talk about it.

    Best to you and your continued NED, PET or not to PET.....
  • D Lewis
    D Lewis Member Posts: 1,581 Member
    #3
    18 month PET CT
    Symptoms??? Anthem Blue Cross stated that, as I was showing "no symptoms" there was no medical need for my 18-month follow-up PET CT. This following the "clean" scan I got back at the 3-month mark.

    I immediately contacted my Oncologist and reminded him of my on-going hoarseness, difficulty swallowing, and occasional aspiration of food (hint; these are the big 3, symptom-wise.) He filed an appeal, and a week later, Anthem Blue Cross contacted me again to tell me that my PET CT had been okay'd.

    Deb
  • KTeacher
    KTeacher Member Posts: 1,103 Member
    #4
    D Lewis said:

    18 month PET CT
    Symptoms??? Anthem Blue Cross stated that, as I was showing "no symptoms" there was no medical need for my 18-month follow-up PET CT. This following the "clean" scan I got back at the 3-month mark.

    I immediately contacted my Oncologist and reminded him of my on-going hoarseness, difficulty swallowing, and occasional aspiration of food (hint; these are the big 3, symptom-wise.) He filed an appeal, and a week later, Anthem Blue Cross contacted me again to tell me that my PET CT had been okay'd.

    Deb

    Thank you
    I have never had a clean scan. Thank you so much for posting. The steam coming out my ears has lessened! I was dumbfounded when I finally got the information. I beleive that Anthem is not playing well with Stanford again and doesn't want me to have anything but doctors appointments there. My radiologist here in Merced didn't want me to have the PET locally. I see my doctor in April, I will discuss the side effects oops, symptoms with him. My sister will also be relieved. Friday a.m. the song by Martina McBride was on the radio as I was driving to school, after I pulled myself together I gave her a call just to say 'Thank you' for being my sister and all of the help and support she has given me (she is my most excellent scribe at ALL of my appointments) by the afternoon I was letting her know about the PET--we were both shocked.
  • D Lewis
    D Lewis Member Posts: 1,581 Member
    #5
    KTeacher said:

    Thank you
    I have never had a clean scan. Thank you so much for posting. The steam coming out my ears has lessened! I was dumbfounded when I finally got the information. I beleive that Anthem is not playing well with Stanford again and doesn't want me to have anything but doctors appointments there. My radiologist here in Merced didn't want me to have the PET locally. I see my doctor in April, I will discuss the side effects oops, symptoms with him. My sister will also be relieved. Friday a.m. the song by Martina McBride was on the radio as I was driving to school, after I pulled myself together I gave her a call just to say 'Thank you' for being my sister and all of the help and support she has given me (she is my most excellent scribe at ALL of my appointments) by the afternoon I was letting her know about the PET--we were both shocked.

    KT!
    I forgot you were being seen at Stanford too. I see Dr. Michael Kaplan, Chief, Head-Neck Surgical Oncology Unit, but it was one of his medical staff members who really went to bat for me with Anthem - Russell Miles. I forget what his title is, but I can hunt it down if you need it.

    Deb
  • D Lewis
    D Lewis Member Posts: 1,581 Member
    #6
    D Lewis said:

    KT!
    I forgot you were being seen at Stanford too. I see Dr. Michael Kaplan, Chief, Head-Neck Surgical Oncology Unit, but it was one of his medical staff members who really went to bat for me with Anthem - Russell Miles. I forget what his title is, but I can hunt it down if you need it.

    Deb

    Oh yeah, ...
    We ALL have hoarseness, difficulty swallowing, and occasional aspiration of food to some extent, we just usually take it for granted, and stop telling our doctors about it. TELL THEM! Tell them you are 'very concerned.'

    Deb
  • KTeacher
    KTeacher Member Posts: 1,103 Member
    #7
    D Lewis said:

    KT!
    I forgot you were being seen at Stanford too. I see Dr. Michael Kaplan, Chief, Head-Neck Surgical Oncology Unit, but it was one of his medical staff members who really went to bat for me with Anthem - Russell Miles. I forget what his title is, but I can hunt it down if you need it.

    Deb

    I know Russell
    He took out my 50 stitches on my upper lip. I think that my picture is still on his phone, he needed to let Dr. Yoa see my progress. He happens to be the one that was also on the peer to peer discussion with insurance and withdrew the request for the PET Scan. Thank you again, I talked to my sister (so as not to alarm her at the next appointment) ande let her know that I will be letting the doctor know the things that are going on and not using the terms 'my new normal.' Yes to all of the above symptoms. Last week I woke up with acid reflux coming up, I only had one Nexium left, called my endo guy in town (at least this time he didn't ask me about the weight loss!) Got my Nexium and sleep with a wedge pillow (and my fleece around my head and my extra fleece blanket and my afgan . . . such a lovely sight--also thinking about trying my CPAP machine again, it has a humidifier on it. I feel like my grandkids with their blankies!
  • KTeacher
    KTeacher Member Posts: 1,103 Member
    #8
    D Lewis said:

    KT!
    I forgot you were being seen at Stanford too. I see Dr. Michael Kaplan, Chief, Head-Neck Surgical Oncology Unit, but it was one of his medical staff members who really went to bat for me with Anthem - Russell Miles. I forget what his title is, but I can hunt it down if you need it.

    Deb

    PA
    Russell is a PA. I really like Angie the nurse (she seems to coordinate everything that is going on, besides letting me know that the biopsy results last summer was mets. Poor girl, she felt so bad.

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