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Yes Terry my pulm doc did recommend 3 months but my insurance tried to say nope 6 months, and the pulm doc office is the one that told me that the ins denied it so they will just do 6 months like they didn’t fight it ..I’m the one that says no ..I don’t care if I have to pay out of pocket I’m getting a 3 month scan. So ty Michelle I will call pulm office to have the doc call the insurance to say 3 month is necessary..hope it works ...thanks guys ..love and light ❤️
Insurance companies! After my LC diagnosis I’m embarrassed to have worked in the industry. Fortunately I did run the appeals department for three major insurers.
Lisa if you have a denial in writing then excercise your appeal rights. The pulmonologist will need to do a peer to peer review by phone. My PET was denied & the pulmonologist got it approved after a lengthy argument.
there is a second level appeal and then a third level called Independent Review. Keep appealing!
There is also a separate complaint process. I’m not sure if it’s the policy through your company? If so then file a complaint with the broker who sold the policy. The Department of Insurance can also be a resource too.
The key is to ensure the doctor’s office provides sufficient documentation & rationale for the proposed treatment plan.
My initial chemo was denied & I later found out my doctor’s documentation was perfect but the hospital finance team didn’t send it to the insurance company.
Bottom line is that docs have gotten pretty well versed in the insurance delay tactics. Try not to worry too much & I think you’ll be fine. Hang in there!