Bev'sSister Posted May 24, 2007 Share Posted May 24, 2007 Yet again, Blue Cross wants to deny my sister a PET scan, even after the Dr. told them the last time that the CT scan did not show the spot on her Sternum and had the PET scan not been given to her for free they would have never even know she had a spot. He told them the PET scan saved her life. What steps can we take to have the insurance company reconsider or does anyone know the cost of PET scan? FRUSTRATED AND ANGRY!! Quote Link to comment Share on other sites More sharing options...
Eileen Posted May 24, 2007 Share Posted May 24, 2007 I wonder why? Can't you fight it and take to the next level? My insurance never ever denied any pet scan for me---even after clear ones. They are very expensive , I was told about 4,000 dollars Quote Link to comment Share on other sites More sharing options...
dchurchi Posted May 24, 2007 Share Posted May 24, 2007 When Alan had his 1st PET Scan his dr. very carefully worded the order. It appears that PET scans for SCLC can be denied. I believe the cost for Alan's was about $4,000 I would have to look at the EOB. Quote Link to comment Share on other sites More sharing options...
ernrol Posted May 24, 2007 Share Posted May 24, 2007 Bobby, I think your sister needs to call the insurance company and ask them what their reason is for denying the PET scan. It might be that the request can be worded differently by her doctor to get approval. My policy is to find out what they want then give it to them. Stay positive, Ernie Quote Link to comment Share on other sites More sharing options...
laban Posted May 24, 2007 Share Posted May 24, 2007 I believe they like to deny to see if they can get away with it and if the Doctor will write a detailed letter of necessity that should do the trick. Blue Cross can be very tricky and try and not pay. It's just the way it is. Good luck. Quote Link to comment Share on other sites More sharing options...
twodogs Posted May 25, 2007 Share Posted May 25, 2007 I think all these folks are right. You need to find out why and what Blue Cross want or needs and then work that part. I'm not trying to oversimplify the problem but I had BC/BS when I was first diagnosed and they never balked on anything. Keep after them. Prayers and best wishes for you both. John Quote Link to comment Share on other sites More sharing options...
Bev'sSister Posted May 25, 2007 Author Share Posted May 25, 2007 Thanks for all of your replies. Her Dr. is on vacation now and will be back on the 12th. He wanted her to have the PET done on the 8th, I believe. I tried to get her to give me her policy #, but she said she wants her Dr. to handle this. In the meantime, our neice is working on getting her another free Pet scan, so please pray with us that this works out. I have also asked Dr. West what he thinks and I am waiting on his reply. I tell my sister about Dr. West all the time and she likes him..so depending on what he says... Thanks to all Bobby Quote Link to comment Share on other sites More sharing options...
Geri Posted May 25, 2007 Share Posted May 25, 2007 I also have that insurance and I have a case manager who deals with all the red tape and expedites anything out of the ordinary. If your sister doesn't have this already maybe she should make enquiries, mine has seen me through a couple of mine fields and gave me advice after my breast MRI was denied.......I didn't have to use it as the broker was already appealing it ( they've now paid the bill) but she was very helpful and is keeping tabs on me through my bc struggles. Hope they change their minds and she gets the PET - they paid for mine after my sclc tx. Geri Quote Link to comment Share on other sites More sharing options...
teriw Posted May 25, 2007 Share Posted May 25, 2007 Bobby, I don't know. Bill's had 3 PET scans. Although they've required pre-approval, to my knowledge there's never been an issue. I don't understand why a PET wouldn't be considered a necessity for SCLC. Definitely praying for Beverly and another free scan. Quote Link to comment Share on other sites More sharing options...
Flowergirlie Posted May 25, 2007 Share Posted May 25, 2007 It is frustrating that we have to put all the pieces together for the health insurance in order for them to oblige their end of the deal. It is like pulling teeth to get anything done. It is as inefficient as the DMV or other ill organized government office. It would seem that the insurance companies would rather do what is necessary for an illness. I had to call and call and call for my dental insurance to approve my wisdom tooth being pulled when it was making me VERY sick and finally they treated it as an emergency, a week later, and it cost them more money! Just what we all need, some cancer and some health insurance problems. I am sorry you are going through this yet again. I swear to you that somehow I am going to help our healthcare system be more functional rather than stressing us out so much that we become sicker. Hope I haven't been offensive...I say call and call and call until her insurance gets the point. My best regards...Flowergirlie Quote Link to comment Share on other sites More sharing options...
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