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Denied cat scan

rdoyd2
Posts: 80
Joined: Aug 2016

I had scans every 6 months for two years, so I had the one that diagnosed it then one I think a month after my neph and then I had them every six months, so I had 6 total up to that point. then we went to every year. I had that first yearly scan last year.   I was supposed to have my yearly scan next week but Aetna refused it said I could have ultrasound and X-ray. My doc said that we would do yearly scans till I reached 5 years out then we would alternate with the ultrasounds every year. This is  my fourth year scan so I quess next year I will have the cat scan. Should I complain and try to force the cat scan or just go with it. 

icemantoo's picture
icemantoo
Posts: 3353
Joined: Jan 2010

rdoyd2,

 

Fight back as Aetna is currently getting a lot of bad publicity on its medical reviews. Will your doctor join you with this fight?

 

Icemantoo

rdoyd2
Posts: 80
Joined: Aug 2016

I dont know yet , just found out yesterday going to talk to him later today. Has anyone else had this problem? I thought it was normal to have yearly scans for 5 years?

Trinityo88
Posts: 22
Joined: Jan 2018

I am due to have a robotic partial neph soon hopefully.  When my doctor told me about the after care plan he said 3 years of scans and 5 years of blood tests.  I have read several articles and have heard both versions.  Not sure which is right or which is wrong.  Fight for what you think is right for you!

ImNotDeadYet's picture
ImNotDeadYet
Posts: 244
Joined: Apr 2017

We have to become advocates for ourselves, sometimes with our doctors and sometimes with the insurance companies. And as IcemanToo said, Aetna is in hot water right now for decisions such as this. Probably a good time to appeal this one, especially if your doctor will support you with it. Good luck!

Hd67xlch's picture
Hd67xlch
Posts: 152
Joined: Apr 2016

My wife has Aetna and she always gets denied scans and has to appeal them. You need to press the issue, it was on my 5 year ct scans they found that my rcc had returned and metastiszed. Good luck

rdoyd2
Posts: 80
Joined: Aug 2016

Talked with doc , he says he is ok with ultrasound and X-ray this year 

rdoyd2
Posts: 80
Joined: Aug 2016

next year I will get cat scan, from now on I will alternate every year. Doc says because im a chromie and had no sarcomatoid or necrosis that I'm low risk. My tumor was 11.7 cm. I was stage two. I trust my doc so if he says I alternate every year I will. 

foxhd's picture
foxhd
Posts: 3183
Joined: Oct 2011

I have a $100 that says your doc would not accept xray and US if it was him or his family. Be your own advocate. I doubt they can show you a dated protocol saying CT scan is not indicated.

Make the phone call. Insist on speaking to supervisors. Ins. co. have a practice of denial without proper review. Aetna has been caught and exposed.

The biggest mistake you will ever have a chance to make is not being a squeeky wheel. Any weakness in your aggressiveness will be taken advantage off. They care nothing about you. You are a chart number. Nothing more. Don't accept it.

stub1969's picture
stub1969
Posts: 920
Joined: Jul 2016

You are getting good advice, but one we should all listen to is the latest post by Fox.  He is right on with his advice!

Good luck!

Stub

rdoyd2
Posts: 80
Joined: Aug 2016

i was going to start alternating after my 5 year scan any way . I didn't like it but that's what doc said was required .  Doc said he's fine with it so he won't press it. I think I should have scans at least this year and next year then start alternating I quess.

rdoyd2
Posts: 80
Joined: Aug 2016

Should I get scans every year for life or is there a time when we start alternating ?

rdoyd2
Posts: 80
Joined: Aug 2016

Fox your right ! I'm going to force the  issue. Hd thanks for your input I'm glad your doing well now. That must have been a schock 

Retcenturion's picture
Retcenturion
Posts: 240
Joined: Mar 2017

My doctor is following the National Comprehensive cancer Network Guidelines for kidney cancer. Follow up an category 2b. Baseline CAT or MRI , then CAT ,MRI, or ultrasound 3to 6 months for at least 3 yrs then annually up to 5. Check it out . It explains for me what I will be following. You have nothing to lose by asking for the procedure. You become an annoyance to someone who doesn't know you so what. You've earned the right to be listened to at the minimum.

todd121's picture
todd121
Posts: 1449
Joined: Dec 2012

And 5 years is a bullshit cutoff date. There's no data to support stopping at 5 years with RCC. They are taking data from other cancers which have data to support stopping at 5 years and applying it to RCC.

If you need to, find another doctor and get another opinion.

Perhaps you feel some pain in your side? If I had to, I'd go with that approach. Lol. I'm serious here. I would insist on annual CT scans chest/abdomen and pelvis even after 5 years. I'd pay out of pocket even to get them, but I'd definitely push them in any way I can. You want to catch anthing early. If you wait for symptoms to show up, it will very likely not be something operable by the time symptoms show up.

Todd

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