What would you do?
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.
Comments
-
No way would I let the chips fall....
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
0 -
Tough Call
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"
0 -
I agree with John, get that
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
0 -
OPS stuttered with the fingers
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
0 -
I agree
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.
0 -
Got nodules. Got scans.
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
0 -
It's your health
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 fuckem and how" pay a little now for the preventative, or pay up the **** 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
0 -
Hmmm...my 2 cents .....luv4lacrosse said:It's your health
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 fuckem and how" pay a little now for the preventative, or pay up the **** 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
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
0 -
I agree
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
0 -
rat, i agree w/all the
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
0 -
Make sure...
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
0 -
Very good perspectives
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 **** out. Thanks guys.
0 -
Scansratface said:Very good perspectives
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 **** out. Thanks guys.
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
0 -
BS Huh...ratface said:Very good perspectives
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 **** out. Thanks guys.
That explains the grief your insurance company is giving you.....
Their last two initials are BS....
JG
0 -
Scans...
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
0
Discussion Boards
- All Discussion Boards
- 6 CSN Information
- 6 Welcome to CSN
- 121.8K Cancer specific
- 2.8K Anal Cancer
- 446 Bladder Cancer
- 309 Bone Cancers
- 1.6K Brain Cancer
- 28.5K Breast Cancer
- 397 Childhood Cancers
- 27.9K Colorectal Cancer
- 4.6K Esophageal Cancer
- 1.2K Gynecological Cancers (other than ovarian and uterine)
- 13K Head and Neck Cancer
- 6.4K Kidney Cancer
- 671 Leukemia
- 792 Liver Cancer
- 4.1K Lung Cancer
- 5.1K Lymphoma (Hodgkin and Non-Hodgkin)
- 237 Multiple Myeloma
- 7.1K Ovarian Cancer
- 61 Pancreatic Cancer
- 487 Peritoneal Cancer
- 5.5K Prostate Cancer
- 1.2K Rare and Other Cancers
- 539 Sarcoma
- 730 Skin Cancer
- 653 Stomach Cancer
- 191 Testicular Cancer
- 1.5K Thyroid Cancer
- 5.8K Uterine/Endometrial Cancer
- 6.3K Lifestyle Discussion Boards