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How do you stand insurance issues?

Betsydoglover's picture
Betsydoglover
Posts: 1256
Joined: Jul 2005

Hi - So I just checked my insurance online and my 4/11 PET scan was "denied"! Reason - this charge is not one your provider is allowed to bill! OK, this has to be a clerical error (perhaps an error on purpose?). Why do I need to go thru this stress. Can't talk to a human until during the day tomorrow. I absolutely HATE this. Nothing costs me more stress than PET scan claims (even the scans themselves are hardly more stress). This is the worst - always before they have delayed by requesting "statement of medical necessity". Now, this one is simply ridiculous. In my heart I know this will end up working out, but frankly my gut reaction is that I am a "damn cancer patient and I don't need this!"

Am I being unreasonable. I freak out about having to possibly pay $12000/yr for PET scans if the insurance co refuses and also freak at having to fight these battles with people who process claims differently every time they do them.

AARGH!!!!!!!!!!! Am I ever frustrated!!!!!!!!!!!!!

Betsy

hopefulone
Posts: 1048
Joined: Jan 2007

I hear ya Betsy. We had to fight to get my husband on the xeloda , even though it saved the insurance company money since the sponsor is picking up the tab for the pills. Go figure. ! I requested last week that they get approval for the ct for next week ahead of time, because I think it's an insurance protocol to look for any reason to deny payment. I figure it's written somewhere to look for loopholes. I'm sure it will work out, but as you say . it's aggravating to have to deal with this on top of everything else. God Bless

Diane

taraHK
Posts: 1961
Joined: Aug 2003

Maddening. I feel for you. I have long believed that anyone diagnosed with cancer should immediately be issued a full-time secretary/assistant -- just keeping track of all the paperwork is so time-consuming -- not to mention the "fights" we have to face from time to time. I wish you all the best -- in the battling The Other Dragon (insurance company). Sheesh.....

KathiM's picture
KathiM
Posts: 8077
Joined: Aug 2005

I usually start out nice, and get increasingly loud....

Threaten the Insurance Commission, if it's them...JCOH if it's a hospital,Medical Board if a doctor...
Ask for a copy of what the doc sent to the insurance...and then offer to call them youself. Sadly, the insurance will listen to a patient most times before the doctor...but, don't lose your cool...remember, start soft, get tougher!

Perfect example: my ct scan/MRI. Ordered last Monday, because I am having symptoms. Thursday I called my doctor's front insurance gal...ask if I could help speed it along by calling and 'yelling' at my insurance (they can be PAINFULLY slow). See, I was her 'buddy'...and, I was calling to remind on the off chance she hadn't done anything yet...(which, it turns out, she probably hadn't). She made a statement about it being "only since Monday". I said "Well, for most folks, it's only 3 days...for me, 3 lifetimes...2 hours after I left your office, I had myself with stage 10 colon cancer".

I decided to wait over the weekend. This afternoon, she called, with the imaging center on the other line...ready to arrange both tests...

Had the insurance been the culprit...would have called and said "I was wondering if I could check on my request for service from my doctor" "Could it be that it got lost?"...again, helpful, not blameing....Once, tho, went all the way to saying to one balky gal..."See that check box on the request that says 'STAT'? You and I BOTH know that this requires a response from you, either way, within 24 hours. It's been 3 weeks. I would VERY MUCH appreciate your response back to my doctor within the NEXT 24 hours...since you are in violation. And, should you deny, I need to appeal to the commission as soon as possible." She KNEW she was in the wrong....

All that aside, I'm sorry you have to fight 2 beasts....one was cancer, the other, the people that are supposed to be HELPING you fight...sigh!

BIG Hugs, Kathi

vinny3's picture
vinny3
Posts: 933
Joined: Jun 2006

Dealing with insurance companies is very frustrating. I have dealt with them on both sides- patient and physician. There seems to be a standard practice to initially deny claims, in some cases, perhaps in hope that the people won't pursue it. There is presently a class action lawsuit, just settled, with Blue Cross where they had denied some claims as being fraudulant when the patients were diagnosed with some condition within 3 months or so of getting the health insurance even if there was no proof of that. If you can stand it, call the insurance company and ask them what it means that " this charge is not one that your provider is allowed to bill". I have never heard that response before. I just got done with dealing with the billing offices of multiple medical clinics for about $6000 in bills as my wife had some tests done just prior to going on Medicare but our insurer, who gladly accepted our premiums, had assumed that she was on Medicare, even though I had notified them she was not, and denied the claims. They finally were taken care of. Sorry for the long response but I share your frustration. It would be nice to have one uniform health system for all.

Dick

Betsydoglover's picture
Betsydoglover
Posts: 1256
Joined: Jul 2005

Hi all -

Thanks for your support. I talked to the insurance co this afternoon, actually talked to a smart person, and she immediately agreed this PET scan denial (at least for the "not a covered expense" reason) was a "mistake". So, now it goes back for resubmission with the usual 10-15 business days of "reprocessing". That's OK - this woman was was really nice - but I know the next thing will be to request medical records (but that won''t happen for another 2-3 weeks). So, while, fortunately, the woman I spoke with today was really great, overall, I still think that the insurance company policy is to delay PET scan payments, by whatever means, as long as possible. I am not generally a hugely cynical person, but after dealing with these insurance issues for close to two years, I am becoming one!

The funny thing is that EACH of my chemo treatments back in 2005 cost about 3 times as much as the PET and they were paid within 5 days of my treatment - no questions asked. And I think if I were still on these treatments, the $$$ would be flowing. But, they have a bug up there about paying for PET scans.

OH, well, I guess I should be just happy that the insurance company agreed to resubmit the claim without it being "an issue".

One step at a time..............

Betsy

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