Options Question

AMomNETN
AMomNETN Member Posts: 242
edited March 2014 in Breast Cancer #1
Yesterday I received notice that my insurance company denied my drs. request for me to have a PET Scan. They deemed it medically unnecessary. What other tests can the onc. do to make sure the cancer is gone. My blood work is clear for now but by the time it shows up in the blood it is probably more advanced. I finished chemo July 16th. Any suggestions or what your onc. did is greatly appreciated.

Janie

Comments

  • SIROD
    SIROD Member Posts: 2,194 Member
    #2
    PET Scan
    A PET Scans are very expensive and insurance companies often deny covering the cost when there is no medical necessity for them.

    PET scans are done when there is active cancer or there are symptoms and other scans support cancer activities.

    You are still in the early stages of post cancer and are still nervous about it returning. It is very common to feel this way. In due time, you will feel more confident about not searching for cancer.

    If blood test work for you, that is a good way to check. Blood test never revealed anything for me and I don't do markers anymore.

    This is a time to learn how to go back to your new normal, living without cancer. Enjoy and embrace it!

    When and if cancer ever returns, it really doesn't make any difference whether or not it is caught early. Once a breast cancer cell takes a hold in another organ (not local lymph nodes or around the area of the original cancer) but in bones, liver, lungs, brain, then it is always there. When women say, "I'm NED" after being diagnose with metastasis, the cells are still there, hidden but there to wake up another day to create more havoc.

    Enjoy this gift you have now.

    SIROD
  • AMomNETN
    AMomNETN Member Posts: 242
    #3
    SIROD said:

    PET Scan
    A PET Scans are very expensive and insurance companies often deny covering the cost when there is no medical necessity for them.

    PET scans are done when there is active cancer or there are symptoms and other scans support cancer activities.

    You are still in the early stages of post cancer and are still nervous about it returning. It is very common to feel this way. In due time, you will feel more confident about not searching for cancer.

    If blood test work for you, that is a good way to check. Blood test never revealed anything for me and I don't do markers anymore.

    This is a time to learn how to go back to your new normal, living without cancer. Enjoy and embrace it!

    When and if cancer ever returns, it really doesn't make any difference whether or not it is caught early. Once a breast cancer cell takes a hold in another organ (not local lymph nodes or around the area of the original cancer) but in bones, liver, lungs, brain, then it is always there. When women say, "I'm NED" after being diagnose with metastasis, the cells are still there, hidden but there to wake up another day to create more havoc.

    Enjoy this gift you have now.

    SIROD

    Thanks
    Thank you so much SIROD. I do live life to the fullest and enjoy each day. I know this was caught with a mammogram so I just want that added assurance at this point. I'll just do what the onc. suggests. I just want to be proactive but even the insurance co. or the com. that rejected the scan can't tell me what would be approved. I don't like being in the dark so to speak. I'm still learning all this is in God's hands not mine. Don't like it but I'm learning.

    Janie
  • RE
    RE Member Posts: 4,591 Member
    #4
    options
    Hi Janie,

    I understand your concern and I too would be upset if my doctor deemed a test needed that the insurance company decided was not required. In the past I have had ultrasounds done to check for masses in the organs that are in the abdominal cavity, if anything is seen to be abnormal then an MRI or CT scan has been ordered. I have only had two PET scans both right after treatment. If you feel strongly about need for the scan you can contact your insurance company and request an explanation.

    My best to you,

    RE
  • jessiesmom1
    jessiesmom1 Member Posts: 915 Member
    #5
    PET/CT scan denial
    I hate that an insurance company can essentially tell my treating doctor what tests he can and cannot order for me. That being said, I suggest that you find out what the Appeals procedure is for your insurance carrier. That will probably include a written statement of necessity from the doctor ordering the scan. Follow their instructions explicitly and with your doctor's support you may get lucky. Hopefully he is a good letter writer.
  • carkris
    carkris Member Posts: 4,553 Member
    #6
    RE said:

    options
    Hi Janie,

    I understand your concern and I too would be upset if my doctor deemed a test needed that the insurance company decided was not required. In the past I have had ultrasounds done to check for masses in the organs that are in the abdominal cavity, if anything is seen to be abnormal then an MRI or CT scan has been ordered. I have only had two PET scans both right after treatment. If you feel strongly about need for the scan you can contact your insurance company and request an explanation.

    My best to you,

    RE

    I had Ct and bone scan prior
    I had Ct and bone scan prior to treatment. i will not recive any others unless symptomatic. I get blood work.
  • Alexis F
    Alexis F Member Posts: 3,598
    #7
    jessiesmom1 said:

    PET/CT scan denial
    I hate that an insurance company can essentially tell my treating doctor what tests he can and cannot order for me. That being said, I suggest that you find out what the Appeals procedure is for your insurance carrier. That will probably include a written statement of necessity from the doctor ordering the scan. Follow their instructions explicitly and with your doctor's support you may get lucky. Hopefully he is a good letter writer.

    I always thought that a PET
    I always thought that a PET scan would be part of your treatment. I didn't know an insurance company could deny it. Could your oncologist change the procedure number or something to make them accept it? I know that works sometimes for some.


    Good luck!
  • disneyfan2008
    disneyfan2008 Member Posts: 6,583 Member
    #8
    sorry to hear
    I feel terrible that your coverage wont' pay for your test...can you appeal it?
  • missrenee
    missrenee Member Posts: 2,136 Member
    #9
    disneyfan2008 said:

    sorry to hear
    I feel terrible that your coverage wont' pay for your test...can you appeal it?

    Many doctors do not follow up with PET scans
    My oncologist said even if I were her sister or best friend, she would not do a PET Scan just as a follow-up to chemo/rads. Like one of the other gals said, if there was a symptom that warranted it, that would be a different story. But once a metastatic lesion is found, the treatment is only that--a treatment. I, too, wanted the PET to hear someone say, "There is no more cancer!" but apparently as much as we want to hear and believe it, it's not definite. We can, however, be in remission for a very long time--as so many on this board have proven. There just is no cure for this beast--only treatment at this point. So, as another dear sister said, it's in God's hands.

    I hope you can come to some feeling of peace with all of this.

    Hugs, Renee

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