Insurance Company Woes

[Janet B]

I just got the news - my insurance company is refusing to pay for my PET scan next week. I want to scream, I want to kick something, I want to cry, and I did sit down and eat a whole bag of Fritos. This has been a month long argument between the insurance company and my doctor and they will not budge. Their reason - well first they said they wouldn't pay for another PET until my chemo was complete. When the doctor got them to understand that Tarceva was ongoing, they changed their story to they won't pay because my last tests were so good - I don't need any more. This is an insurance company arguing with a Lung Cancer specialist from Yale New Haven Hospital!!!! And so I have to cancel my tests, and try to fight them some more - and take a few Ativan to get over the scan anxiety that is now being prolonged - and I am at a loss. This is the most defeated I have felt since the week of diagnosis.

I am sorry that I am rambling on and on, but I needed to vent and I knew you all wouldn't mind! Any one else out there have this fight? Any suggestions?

[Patti B]

((((Janet))))

Gee - I am so sorry for you and now I am mad, too. Don't these people realize we have enough to deal with just having cancer?? I just can't understand how they can decide what you NEED - isn't that what the docs are for???

Wish there was more I could do for you - I will eat a bag or two of Fritos, too, and sit here being p*ssed off at your insurance company.

Hang in there, girlfriend. Maybe your doc can still pull out the big guns and change their minds!!

Hugs - Patti

[SandraL]

Hi Janet. I can certainly understand your frustration. We all want to know exactly what is going on with our disease and the medical system can be frustrating for sure. Are CT scans an option for you? Regardless I can tell you have a fighting spirit and that will serve you better than any darn PET scan. Don't stop arguing though....eventually break them down! Take care

[Kasey]

Boy, Janet, I know exactly the feeling you have. 3+ years ago I was denied too. Over and over again. I HAD to have it done (had not had one yet) so agreed to self pay. Of course I didn't have to lay out the $$$ the day I went for the test. I gave my insurance info. The WONDERFUL gal in the pulmonologist's office dealt with the insurance for me. Each time it was refused she copied more of my file. After 3 times, she copied the entire file ~ must have been inches thick. Insurance finally agreed to pay. Initially they said I didn't need it because I had already had a CT scan. Then they said is was experimental. Then that it would give no info needed.

I don't know what you can do, but I feel your frustration as I suffered it myself. I hope someway, somehow, you get this done. When insurance non-medical people can trump our LC specialists ~ well ~ that's a very sorry example of our health care. I send you the best of luck! Hope next time we hear it's a go for the PET.

Kasey

[Yorktown Linda]

Sorry you're going through all that. Just what you need on top on the cancer, right?

I had a similar experience after my CAT scan showed a new growth. My oncologist wanted to wait six weeks and then repeat the CAT scan. The insurance company said "Why does she need a CAT scan; she just had one?" The most galling part was that with the rebate that the insurance company gets from the radiologist, they only pay $150 out of the $1200 bill!

Anyway I read an article online called "When Your Insurance Company Wont Pay: 12 Tips" The URL is:

http://thyroid.about.com/cs/newsresearc ... ncepay.htm

In my case,tip #12 was the winner. My husband's company's insurance administrator switched from billing through Qualcomm to Blue Cross of California without notifying the employees. This resulted in a reduction of benefits and our needing prior approval where we never needed it before. His company is self-insured and we are therefore covered by the ERISA law. I contacted the NYS insurance dept. who referred me to the US Dept of Labor. They confirmed that failure to notify us of the change in insurance was a violation of the law. We took that to Human Resources and voila! the scan was approved.

Results were not good, but that's another story.

Best of luck. I know what you're going through and my thoughts and prayers are with tou.

Linda

[Ry]

Our oncologist had one employee that dealt directly with the insurance companies whenever something was denied. Are you sure there is no one at your doctor's office that can do that for you? I also remember someone posting that the Lance Armstrong Foundation is often helpful with these kinds of situations.

[RandyW]

my turn hope these help some..

http://lchelp.org/l_community/viewtopic ... +pet+scans

PAtient Advocate foundation might be able to give you some advice

http://www.patientadvocate.org/

THese are the only things I can find right now though.. Hope something helps and will keep looking in case I think of something...

[Janet B]

You guys are the best group of people

I am calming down over the weekend - taking a breath - and then I am going to reread all the stuff you sent and put on my fighting gloves! And as always - God will provide somehow - no worries!

Thanks

[mike_s]

If all else fails, contact the Insurance Commissioner for your state to see if they might help. States vary, but they are supposed to be an advocate for you, not the Insurance Company.

Insurance companies really do not like phone calls from that office, because they have the power to pull the Insurance Companies license to operate in your state.

Best Regards,

mike_s and Naphalai

[Janet B]

Thank you all for your replies - my Doctor did end up convincing them - and I had my tests!!!

I hope all your replies will be helpful to someone else in the same situation. This board is the most wonderful place - I am blessed to have found you all!

[Barbb]

That is THE BEST NEWS!!

Barb