denial

vinny59
vinny59 Member Posts: 1,036 Member
in Lymphoma (Hodgkin and Non-Hodgkin) #1
Hi guy's need to vent a bit, my Oncologist ordered a PET scan for May, and my Insurance company denied it! There reasoning was it's looking for evidenced of disease. Hello!!!!!!!! Just don't make any sense. I had no symptoms to begin with only a cough, when dumb luck found my NHL through a routine PET scan, not to mention that I still have a uptake in my hip bone. My wife calls my scans a security blanket, a bit of reassurance that everything will be alright for awhile. Well anyway it's my doctors fight now, hey looking at the bright side, I just saved 400.00 in my deductible payout!!!!!!! Thanks for listening............. Vinny

Comments

  • onlytoday
    onlytoday Member Posts: 609 Member
    #2
    SUCH NONSENSE!!!!
    Vinny,
    Oh boy, don't get me started. Insurance Companies can really do some "interesting" things. How dumb is that?? You are a NHL survivor and NEED that test!! If they knew ANYTHING about our disease they would get it. I'm sure with some prodding from your oncologist all will be well. BUT... what gets me is that we (especially) need to limit stress in our lives - so then they pull stunts like this and stress us out!!! UGGGGHHHHH!!!!

    Praying that this is straightened out soon, you get the PET and it shows NED. And THEN you can pay that deductible! Haha :)

    Hugs,
    Donna
  • jimwins
    jimwins Member Posts: 2,107
    #3
    Frustrating to say the least....
    Obviously, we as patients and caregivers have enough to worry about.
    It's common practice to have regular scans after cancer treatment.
    If these scans result in early detection and treatment, you would think
    it saves money in the long run?

    I realize managing (the insurance business) is very complex and involves
    mathematical methods beyond most of us. Amongst all the complexity here,
    I think the "human" element often gets ignored/downplayed in the analyses
    and processes.

    I mean it's one thing to say "One out of 10,000 (arbitrary) people will develop
    cancer in the next month". It's another to say, "My daughter is the one
    out of 10,000 people who will get cancer in the next month". It takes on an
    entirely different perspective when it hits home.

    Anyway, I'm trying not to get on a soap box here :).
    Hopefully it will be approved with your doctor's input.

    Hugs and positive thoughts,

    Jim
    DX: DLBL 4/2011, Chemo completed 10/2011, currently in remission. :)
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  • anliperez915
    anliperez915 Member Posts: 770
    #4
    Stress Anyone!
    Hey Vinny,
    What a sure way to stress people out, knowing that you have to get a test done and the freaking insurance companies not letting you get it. It has happened to me but a little different, like constantly getting cancelled appointments and getting them till they get approved. Hang in there and hopefully you can get the test approved so you can relax a bit!
    Take care

    Sincerely,
    Liz
  • miss maggie
    miss maggie Member Posts: 929
    #5
    ???
    Dear Vinnie,

    Can I assume the approval was sent through normal channels????

    All your oncologist has to do, is write another request for a pet scan, or call the insurance company and tell them you have pain in your hip bone, and they need to see
    if there is any cancer activity in your hip. Or if you have any other problems, no matter how slight, this will get you a pet scan. Coughing again, etc.

    Good luck Vinnie. Keep us posted. Love Maggie
  • allmost60
    allmost60 Member Posts: 3,178 Member
    #6
    It's crazy!
    Hi Vinny,
    I'm so sorry you are dealing with a "new" stress! It's hard enough each day to keep a positive outlook without having anything new dumped on our plates. My out of pocket went from $2,000.00 last year to $5,000.00 this year. I just wrote a check for $2,185.00 for my part owed for February's Rituxan infusion. I just had another R infusion on April 10th, plus a CT scan of my pelvis, chest and neck. They charge me seperate for each body area scanned, instead of considering it one scan...makes no sense to me at all, other than I know it's to make more money off of the one scan. I'm sure my next out of pocket bill will be huge, but once I hit the $5,000.00 mark, my part owed will get smaller. I don't know about the rest of you, but whacking a couple grand from the budget every other month is not easy, and each time I write one of those hefty checks, my stress level sky rockets! Ahhhhh...the joys of having cancer!...NOT! Anyways....hang in there Vinny and just let your doctors office fight it out with the insurance company and in the meantime try to keep your stress as low as possible....sooooo easier said than done, I know. Let us know how this turns out for you buddy. Love ya...Sue (FNHL-2-3a-6/10)
  • vinny59
    vinny59 Member Posts: 1,036 Member
    #7
    allmost60 said:

    It's crazy!
    Hi Vinny,
    I'm so sorry you are dealing with a "new" stress! It's hard enough each day to keep a positive outlook without having anything new dumped on our plates. My out of pocket went from $2,000.00 last year to $5,000.00 this year. I just wrote a check for $2,185.00 for my part owed for February's Rituxan infusion. I just had another R infusion on April 10th, plus a CT scan of my pelvis, chest and neck. They charge me seperate for each body area scanned, instead of considering it one scan...makes no sense to me at all, other than I know it's to make more money off of the one scan. I'm sure my next out of pocket bill will be huge, but once I hit the $5,000.00 mark, my part owed will get smaller. I don't know about the rest of you, but whacking a couple grand from the budget every other month is not easy, and each time I write one of those hefty checks, my stress level sky rockets! Ahhhhh...the joys of having cancer!...NOT! Anyways....hang in there Vinny and just let your doctors office fight it out with the insurance company and in the meantime try to keep your stress as low as possible....sooooo easier said than done, I know. Let us know how this turns out for you buddy. Love ya...Sue (FNHL-2-3a-6/10)

    thanks everyone!
    thanks for all the responses. I really helps! I can't agree more with everyone, Sue my out of pocket was 8,000.00 last year, including Lisa's surgery! You can't even write it off! I'm really not stressing about it, it's out of my hands. Thanks again guys!
  • COBRA666
    COBRA666 Member Posts: 2,401 Member
    #8
    Insurance changes
    Vinny.
    I too have seen changes in my insurance. Meds have gone up,second opinions in scans,rise in my deductible,which was $2000 until 6 months ago.Now it is $5000. Gods only knows what else or what else is on the horizon. I have asked why some of the changes. It all boils down to OBAMA CARE.It is a real shame and people better open their eyes to what is happening here and to the future of this country. I guess I set myself up for an offensive remark so I hope you read this beforehand. Your Drs. should win this battle .Afterall its all about the money in their pockets too. Sorry for the negative reply,but when I see what is happening in the insurance and medical field it gets me going.Just hope and pray all goes in your direction.John
  • catwink22
    catwink22 Member Posts: 281
    #9
    vinny59 said:

    thanks everyone!
    thanks for all the responses. I really helps! I can't agree more with everyone, Sue my out of pocket was 8,000.00 last year, including Lisa's surgery! You can't even write it off! I'm really not stressing about it, it's out of my hands. Thanks again guys!

    Me too
    Hi Vinny,
    My insurance has denied a PET twice.

    The first time my Onc was able to get it approved, but the second time I ended up having just a CT (last Mon). My biggest concern was that by getting a CT they had no base line to compare it to, but the PET scans I had been given had a CT scan overlay so that worry was put to bed.

    My insurance deemed it an "unnecessary procedure", because I am not symptomatic. My Onc has assured me that I WILL get a PET maybe once a year or every two years, with the CT in between and the physical every three months is a MUST. And of course if any symptom arises to call right away.

    The CT scan is more detailed and the dose of radiation is far higher in a PET and there are many people on here who have NEVER had a PET and use only CT's. Check with your Onc and see if you have had the CT overlay with your PET, at least that is a little peace of mind that it can be seen if there are any changes.

    Another option is for you to contact your insurance company directly. Fight it along with your physician and put some pressure on them if that's what your Onc feels is in your best interest.

    Best of Luck to you!!
    Cat
  • Avantgardener
    Avantgardener Member Posts: 32 Member
    #10
    catwink22 said:

    Me too
    Hi Vinny,
    My insurance has denied a PET twice.

    The first time my Onc was able to get it approved, but the second time I ended up having just a CT (last Mon). My biggest concern was that by getting a CT they had no base line to compare it to, but the PET scans I had been given had a CT scan overlay so that worry was put to bed.

    My insurance deemed it an "unnecessary procedure", because I am not symptomatic. My Onc has assured me that I WILL get a PET maybe once a year or every two years, with the CT in between and the physical every three months is a MUST. And of course if any symptom arises to call right away.

    The CT scan is more detailed and the dose of radiation is far higher in a PET and there are many people on here who have NEVER had a PET and use only CT's. Check with your Onc and see if you have had the CT overlay with your PET, at least that is a little peace of mind that it can be seen if there are any changes.

    Another option is for you to contact your insurance company directly. Fight it along with your physician and put some pressure on them if that's what your Onc feels is in your best interest.

    Best of Luck to you!!
    Cat

    Appeals
    Here in California the Department of Managed Care oversees HMO insurance plans. They will come up if you google them. They have an appeal protocol in place – not sure where you are, but most states have something similar. They have an appeals protocol in place. You may want to try contacting them and initiating the appeal process. I worked in the insurance field for many years, and this is something that we often did for our clients, often with good success.
    Best of luck!
  • vinny59
    vinny59 Member Posts: 1,036 Member
    #11
    Avantgardener said:

    Appeals
    Here in California the Department of Managed Care oversees HMO insurance plans. They will come up if you google them. They have an appeal protocol in place – not sure where you are, but most states have something similar. They have an appeals protocol in place. You may want to try contacting them and initiating the appeal process. I worked in the insurance field for many years, and this is something that we often did for our clients, often with good success.
    Best of luck!

    thanks Guy's
    Thanks again for the responses, we live in New Jersey, I'm screwed!!! lmao, just Kidding.. Cat thanks for the CT suggestion. For the 7 or so years I've been dealing with cancer, never had a CAT.So maybe its time.... again thanks Vinny
  • scuttlebug11
    scuttlebug11 Member Posts: 175
    #12
    vinny59 said:

    thanks Guy's
    Thanks again for the responses, we live in New Jersey, I'm screwed!!! lmao, just Kidding.. Cat thanks for the CT suggestion. For the 7 or so years I've been dealing with cancer, never had a CAT.So maybe its time.... again thanks Vinny

    hi vinny
    mine would not evev pay in the er for an iv and they knew i had a relspe. (go obama) blessings denise

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