Insurance Denail on extractions before Radiation and Chemo

Carolinacrafter
Carolinacrafter Member Posts: 2
in Head and Neck Cancer #1
 

 




My husband had to have all of his teeth extracted before chemo and radiation could begin.  He was diagnosed with a 4mm mass Stage 3 Supraglottic Laryngeal Cancer.  His extractions had to be done in a surgical hospital setting due to the complications of his mass and restricted airway.  We were even warned that a trach could be possibly placed.  He was not a candidate for office surgery due to his complications.  Has anyone else in the Head Neck cancer forum faced a similar situation that you would like to share?  Now, we are left with a 50,000.00 bill that keeps rising.  Any experiences or suggestions would be appreciated.  i have appealed, and it was upheld that the claim not be paid by the insurance and my only option now is filing a claim through OAH.  I never knew or could even imagine until my husband was diagnosed and began his battle with cancer, just what a patient has to face.  Since the first month of being diagnosed, we have fought for his rights in some way, shape or form.  It has been 8 months since being diagnosed and we are still fighting.  No cancer patient should have to endure the processes of diagnosis, treatment healing and basically fighting for their life, only to endure the battle of proving their rights to an insurance company.  Thank you for all the nice "Welcomes" and assistance with this forum.  It means so much to be able to communicate with those that understand!




 

Comments

  • johnsonbl
    johnsonbl Member Posts: 266 Member
    #2
    Unfortunately I think this is pretty common...

    Typically insurance doesn't like to cover the extractions because they are only to reduce the chance of complications further down the road.  Your hospital should be trying to assist you as well in fighting with the insurance company.  You can also contact your state insurance commissioner as well and look into filing a complaint there too.

    Did your hospital attempt to get authorization for the services before hand?  That typically helps if they can explain in advance why the higher level of care is necessary.  You can also try to negotiate with your hospital over the charges.  Get a lawyer if you have to.  The hospital accepts pennies on the dollar of what they charge from insurance companies...

    I was lucky in that my extractions were done while I was an inpatient for my surgery to remove my tumor...  

  • Logan51
    Logan51 Member Posts: 470 Member
    #3
    I agree-

    with jbl about seeing a Lawyer. Technically, the insurance co. can say it was dental; however, it was medically necessary and ordered by a Dr., so get your ENT/C Medical Team to put that on paper, then take them to court.

    You might want to search the Medicare rule book for backup. I'm on a Feeding Tube for life. The Jevity I put down my FT is food, not medicine, but Medicare has to fully cover it: Chapter 15 and section 120 states so if one is Feeding Tube dependent for all nutrition. Why is that? Because it is a Medical condition: Aspiration due to scar tissue growth around my esophagus opening caused by the 68 Gys of Radiation Medical treatment to my lower throat.

    Good luck. No way the insurance co. shouldn't pay their share of the bill. 

  • kgasmart
    kgasmart Member Posts: 64 Member
    #4
    My insurance company wouldn't pay for my PET scan...

    ...which I only found out after the scan was done. Stupid me, and the stupid radiation oncologist, never sought pre-approval because I figured - hey,  PET scans are routine follow-ups for people who've had base-of-tongue cancer like me. But the insurance company deems them no more effective than CAT scans and denied.

    I appealed twice, lost both times and had no choice but to eat the bill, which I'm still paying off.

    Talk to the hospital/provider, try to work out an agreement on payment, see if they will cut you a break. Often they will, they have wiggle room. Tell them you simply can't pay it all now, you can try to pay it off over time.

    You're absolutely right, it's hard enough for patients and families to deal with the cancer itself, the insurance two-step just makes it all the more exhausting and infuriating.

  • Dagney1924
    Dagney1924 Member Posts: 30 Member
    #5
    kgasmart said:

    My insurance company wouldn't pay for my PET scan...

    ...which I only found out after the scan was done. Stupid me, and the stupid radiation oncologist, never sought pre-approval because I figured - hey,  PET scans are routine follow-ups for people who've had base-of-tongue cancer like me. But the insurance company deems them no more effective than CAT scans and denied.

    I appealed twice, lost both times and had no choice but to eat the bill, which I'm still paying off.

    Talk to the hospital/provider, try to work out an agreement on payment, see if they will cut you a break. Often they will, they have wiggle room. Tell them you simply can't pay it all now, you can try to pay it off over time.

    You're absolutely right, it's hard enough for patients and families to deal with the cancer itself, the insurance two-step just makes it all the more exhausting and infuriating.

    I thought I had everything

    I thought I had everything done as far as insurance approvals before my surgery, but the insurance company is telling me that I have to pay total 

    Fee for the anesthesiologist  because he was out of network.  

  • annie4145
    annie4145 Member Posts: 218 Member
    #6
    Very rare, but if you work

    Very rare, but if you work for a big employer, they sometimes have someone that can talk to the insurance company (such as an advocate.)   I had to go around and around with an insurance company in the past.  It is terrible.   Good luck...

  • johnsonbl
    johnsonbl Member Posts: 266 Member
    #7
    Dagney1924 said:

    I thought I had everything

    I thought I had everything done as far as insurance approvals before my surgery, but the insurance company is telling me that I have to pay total 

    Fee for the anesthesiologist  because he was out of network.  

    Lawyer up...

    It's unreasonable for you to know who your anesthesiologist even is for a surgery let alone whether they are in network or not.

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