Scan Denial

Pewter Member Posts: 24
edited March 2014 in Colorectal Cancer #1
I have what I consider to be an outrageous question: Has anyone in this group been denied approval from their insurance of a diagnostic or therapeutic regimen for their colon cancer?

I was diagnosed with Stage III CC 9/02, had 6 mons 5 F/U, and four months after a liver recurrence was found. I had it successfully resected, followed by more (different) chemo. My CEA levels rose during chemo, and have sort of stayed up, without any significant evidence of disease. My last PET (2 months ago) showed a "questionable" new shadow and an area of increased uptake at the resection site. An MRI (which proves better for my liver) showed the old scar, but nothing else new. The recommendation from the radiologists was to repeat the PET in 2-3 months.

My insurance company has denied the scan, stating it appears the PET is being used for routine surveillence. My oncologist appealled this twice, and failed both times. I'm not sure it can be fought any further, and I sure can't afford the PET on my own.

Anytime I have a CT scan, it shows a lot of abnormalities, and I inevitably have to have a follow-up MRI and then a PET. The insurance company morons don't seem to get it, and I don't know what to do, though I know I won't sit around a wait for a year (when they say a follow-up PET is advised) to see if it is a recurrent lesion.

Any suggestions guys??



  • maura
    maura Member Posts: 7
    You must follow up with an appeal to this denial. Most likely the doctors on the insurance board are not a Onocologist or Hemotologist I

    had the same situation. But, after many letters and fights I won! The insurance company HEALTH AMERICA reinburst me for my pet scan.

    God Bless you,