Stupid Insurance!

Chicklette
Chicklette Member Posts: 225
in Head and Neck Cancer #1

So, my husband was supposed to have a follow up CT Scan tomorrow.  He has only had one since treatment and it was clean (yay!).  This was in August 2017 ... I think that was two or three months after treatment ended.  Well, the insurance is not going to cover his scan tomorrow.  I thought you were supposed to get a scan every six months for the first two years, but our insurance will only cover once a year.  His doctor, who happens to be the chief radiologist at Massachusetts General Hospital, couldn't convince them otherwise.  He is going to keep his appointment with the doctor to get the scope, poke and prod, but this is beyond frustrating.  Thanks for "listening" :-/

Comments

  • Frances_S
    Frances_S Member Posts: 54
    #2

    Please read this post.

    Cost of CT Scans & using 3rd party service providers posted March 1st, by OKCnative.

    We have that problem from time to time. You can appeal it after the scan is done, if that still doesn't work, make monthly payments of whatever you can afford. Eventually you can probably renegotiate what you owe.

  • Frances_S
    Frances_S Member Posts: 54
    edited March 2018 #3
    Most Ins. Policies renew in January

    Most Ins. Policies renew in January. In my book this should have nothing to do with the scan in August of 2017. If the policy renewed in January of 2018 this scan should fall under the new year, under the renewed policy.

  • Chicklette
    Chicklette Member Posts: 225
    #4
    Cigna HDHP

    We have cigna hdhp, so we have to pay the deductible anyway.  He is keeping his appointment with the doctor on Wednesday and if he finds anything suspicious I’m sure a scan will be approved.  It’s like these people are not human.  If it was their loved one, I’m sure the scan would be approved immediately.

  • Tonita
    Tonita Member Posts: 197 Member
    edited March 2018 #5
    Frances_S said:

    Please read this post.

    Cost of CT Scans & using 3rd party service providers posted March 1st, by OKCnative.

    We have that problem from time to time. You can appeal it after the scan is done, if that still doesn't work, make monthly payments of whatever you can afford. Eventually you can probably renegotiate what you owe.

    You can also check with the

    You can also check with the hospital to see what kind of assistance programs they offer.  Depending on your income, you may be able to get some help there.

  • OKCnative
    OKCnative Member Posts: 326 Member
    edited March 2018 #6
    I see someone already posted

    I see someone already posted a link to my previous mention of a similar situation.

    Definitely call other imaging centers in your area. Your hospital was probably charging well above the normal rate and that may be one reason they will not cover another scan. Call other imagining centers and get their rates. You should be able to get a CT scan for a couple of hundred bucks (as opposed to thousands the hospital will charge). Mine is only going to cost $230 for two scans with a reading of those scans. My doctors visit with the cancer center for them to simply read me the results is going to cost double that! Your insurance may agree to cover the much cheaper option. But, if they don't, it's better than having the hospital do it anyway and work out payments. I'd rather pay $230 to a third party provider than payout $2,000 to the hospital.

  • Wednesday
    Wednesday Member Posts: 22 Member
    #7
    Ugh! Cigna!

    I have Cigna too. They use an outside party (EviSource, I think it is) to approve these things. My first CT scan was denied because they said that an ultrasound was the correct way to view thyroid nodules. Note that the CT scan was requested so that they could look at my swollen LYMPH NODE, not thyroid nodules. My doctor had to argue with 5 different people to get it approved. He said he was talking to the doctor in charge of making the decision and said, "Did you actually read my report?" The guy said, "Well I must have." My doc said, "If you did, then you would see that I am not looking at the thyroid nodules. I am looking at a lymph node." He finally got it approved and sure enough, there was a tonsil tumor that I couldn't feel and which couldn't be seen by just looking into my mouth.

    I don't understand why insurance companies think they know better than the doctors looking at the case. I have recently had a follow up CT scan refused because they said that anything my doctors want to see can be seen from the first scan. Mind you, what they want to know is whether the lymph nodes on the right have grown since the first scan. But hey, I'm sure these guys know way better than my doctor at Dana Farber or your husband's doctor at MGH. (eyes rolling!)

    I'm in Massachusetts as well btw! Hi neighbor! :)

  • Chicklette
    Chicklette Member Posts: 225
    #8
    Wednesday said:

    Ugh! Cigna!

    I have Cigna too. They use an outside party (EviSource, I think it is) to approve these things. My first CT scan was denied because they said that an ultrasound was the correct way to view thyroid nodules. Note that the CT scan was requested so that they could look at my swollen LYMPH NODE, not thyroid nodules. My doctor had to argue with 5 different people to get it approved. He said he was talking to the doctor in charge of making the decision and said, "Did you actually read my report?" The guy said, "Well I must have." My doc said, "If you did, then you would see that I am not looking at the thyroid nodules. I am looking at a lymph node." He finally got it approved and sure enough, there was a tonsil tumor that I couldn't feel and which couldn't be seen by just looking into my mouth.

    I don't understand why insurance companies think they know better than the doctors looking at the case. I have recently had a follow up CT scan refused because they said that anything my doctors want to see can be seen from the first scan. Mind you, what they want to know is whether the lymph nodes on the right have grown since the first scan. But hey, I'm sure these guys know way better than my doctor at Dana Farber or your husband's doctor at MGH. (eyes rolling!)

    I'm in Massachusetts as well btw! Hi neighbor! :)

    Ridiculous

    It‘s so frustrating!  I just read the decline letter from Cigna and apparently they won’t cover ANY follow up CT scans. But, they must know best *eyeroll*.  I think we are going to go to a local imaging place to have one done out of pocket.  And hi back, neighbor :)

  • Chicklette
    Chicklette Member Posts: 225
    edited March 2018 #9
    OKCnative said:

    I see someone already posted

    I see someone already posted a link to my previous mention of a similar situation.

    Definitely call other imaging centers in your area. Your hospital was probably charging well above the normal rate and that may be one reason they will not cover another scan. Call other imagining centers and get their rates. You should be able to get a CT scan for a couple of hundred bucks (as opposed to thousands the hospital will charge). Mine is only going to cost $230 for two scans with a reading of those scans. My doctors visit with the cancer center for them to simply read me the results is going to cost double that! Your insurance may agree to cover the much cheaper option. But, if they don't, it's better than having the hospital do it anyway and work out payments. I'd rather pay $230 to a third party provider than payout $2,000 to the hospital.

    Thank you

    i think thats what we will end up doing.  There is an imaging place nearby that is pretty reasonable.

  • Clon
    Clon Member Posts: 20
    #10
    Also sick of Cigna

    I have Cigna too.  I finished treatment in June 2017, close to when your husband went through it.  My Dr. ordered a neck CT because my cancer was in the lymph nodes with unknown primary.  Cigna denied the CT but approved a chest x-ray instead.  My Dr tried to explain an X-Ray will not see the lymph system and since it was primary unknown, we want to make sure the treatment worked. 

    In the end, I got scoped with a camera.  We lost all of the appeals and the Peer 2 Peer conferences my Dr had with Cigna and EviSouce ( the company contracted to approve/deny these scans).  They would not approve at a lower priced facility either since the abstract they use declares diagnosing by CT useless once the patient is 6 months out of treatment. 

    If I become symptomatic they will consider another CT at that time.  Are you kididng me!!!!!  It amazes me that a Dr in an office somewhere will simply override an entire cancer team that has been treating their patient for 9 months.  It all comes down to money, they place more value on that than they do a life, sad.

  • debbiel0
    debbiel0 Member Posts: 134 Member
    #11
    I feel so fortunate!  I have

    I feel so fortunate!  I have the BC (Canada) Cancer Agency looking after me. They take care of everything. I have been afforded the luxury of only having to worry about me,  not the expense of my treatments.  Because I had to travel out of town to the treatment centre, I had some expenses that were a hardship to our family but nothing in comparison to what some of you folks have had to deal with. 

    I cant imagine the added stress you folks are dealing with. I feel so ashamed for being pissy and self pitying before. Thank you all for making me realize how fortunate I am..

    I wish each and everyone of you have a stress free , pain free future 

  • OKCnative
    OKCnative Member Posts: 326 Member
    #12
    One thing to be sure and do,

    One thing to be sure and do, if you have out of pocket balances with your cancer center, call them and see what they can do.

    I had a few thousand owed out of pocket. We simply called and were given several options. The one we took was a 50% reduction in the total bill if we paid it within 20 days. Really took a lot of stress off.

  • ProustLover
    ProustLover Member Posts: 121 Member
    #13
    We're lucky to have Aflac

    We're lucky to have Aflac Insurance, which reimburses cancer-related expenses.  This is a big help defraying sizeable co-pays for each and every radiation treatment, which Univera insurance requires.  Alfac is user friendly and smooth, and I'm glad we bought into it.  I signed up never really thinking we'd have to use is someday....turns out it was a good move.     

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