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Trayce Skidmore Foster


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:D Hi There!

I posted my introduction some months ago, but would like to add some followup. My thoracic ct from 4-09 was clear! yay! Pleural effusion has disappeared (took about 9 months) and lymph nodes even smaller. However, my oncologist had ordered a pet scan but my insurance, Blue Cross/Blue Shield of Texas, denied to pay for the pet and classified it as "investigational or experiemental"! All my anxieties about the scan turned into instant anger! I went ahead and settled for a ct to see how my lungs and thorax looked, and then started talking to family and friends about what to do next.

Based on encouragement from them, I've contacted my oncologist and asked that they request a "detemination" from the insurance. That's my first line of appeal. Also, ironically, I get regular check-in calls from a BCBS nurse who helps me with any questions and follows my treatment, etc. She advised me to ask that the "determination" be made by a peer oncologist, not just any old doctor. I feel better now that I've set those wheels in motion. I will appeal the denial of the pet scan through as many levels as it takes!

I had never worried so much about any scan as that one. I didn't expect it to show any new cancer, but was so looking forward to hearing ned :cry: I hear that's very normal for my "stage" of treatment/recovery.

I was staged 2A adenocarcinoma 6 '08, rll that month, clean pet pre-chemo about 8'08, then 4 infusions carboplatin/taxol 8 - 10 '08. Chest ct in 11'08 was also clear.

I want the pet and am not comfortable making assumptions about my health with this disease! I understand pets cannot detect lesions < 8 mm, so it's possible the scan in 8 '08 missed something. Further, I cannot be certain the chemo killed every cancer cell. My cancer was aggressive--although I was early stage, I still had two foci of cancer in that lobe and the cancer had also metastasized to one lymph node.

My goal is to be diligent and if there's recurrence, I hope to start further treatment without delay. I believe one pet scan a year is a really good idea, at least for now. My oncologist had planned to alternate pets with cts for the first two years, so he thought it was the best plan, too.

Otherwise, I'm feeling pretty good despite new problems with a prior cervical disc fusion--scheduled for a myelogram to determine what treatment I'll need for that! No worries, I can handle a second cervical surgery if necessary.

Anyway, thanks to all for your encouragement and support. Hope I'll see you soon in our chat here. I'll keep posting updates!

HUGS,

Trayce

PS I started a fund here under "Trayce Skidmore" (my maiden name.) So far four have donated a total of $175.00! I'm sending emails to friends and family and hope they'll spread the message.

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  • 1 month later...

Hey friends,

A new update. My "predetermination" through Blue Cross-Blue Shield was processed and I got a letter saying, yes we cover this procedure subject to the usual limitations, exclusions, etc. So my oncologist rescheduled. An hour before I was leaving home for the appointment I get a phone call. My insurance refused to pay, again!

What is going on, I wonder. American Imaging, who is slowly taking over BCBS radiological/imaging decisions, state by state, said because I had a negative chest CT in April no pet would be approved, contrary to the letter I'd just received a few days before. When I called BCBS that same day, the lady said the pet was approved. (Course, I had that chest ct back in April cause they turned down the pet my oncologist had ordered, calling it investigational or experimental that time.)

Seems they've one excuse after another, but the bottom line is BCBS contracts with them to control costs, period. I'm not comfortable with the assumptions this latest decision is based on--that there has been no recurrence with distant metastasis just because chest ct is clear. I've read the research, too, and if the decision-maker at American Imaging had stage 2a nsclc, s/he would want the pet to check for recurrence! I'd lay money on that.

Thanks for letting me vent, but I'm tired of this runaround. I will take it to the next level of appeal....and am seeing my oncologist next Monday. Also, my neurosurgeon has identified a huge new bone spur impinging on my spinal cord, maybe he'll order a pet to check the possibility this is a cancer. Lord, I hope not, but I'll check with him. (I've had previous cervical bone spurs, so it's probably benign, but perhaps that will be my path to pet....)

Trayce

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