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PaulaC

Time for Pet Scan

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I can't believe its time again!

The Dr's office called and scheduled next Pet for Monday March 25th and follow up appointment April 8th. I'm going to do my best not to freak out to much. haha

This is the first Pet since surgery. I'm excited but nervous.

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I really thought it was going to be a CT scan the end of April but the nurse said he wanted a Pet and appointment in April.  I know during my appointment he said he would do a PET but the insurance company usually won't pay. 

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Very true. I had my first PET denied by the insurance company (really?!).  The pulmonologist did a “peer to peer” review & then it was approved.  As long as your medical team jumps through the administrative hoops you’ll be fine.  In addition if you are using an in network provider you will have no financial obligation in accordance with the payer -provider network agreement. You might want to ask for a prior authorization number just for added measure.   Shame this is something we shouldn’t have to worry about! 

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27 minutes ago, Rower Michelle said:

Very true. I had my first PET denied by the insurance company (really?!).  The pulmonologist did a “peer to peer” review & then it was approved.  As long as your medical team jumps through the administrative hoops you’ll be fine.  In addition if you are using an in network provider you will have no financial obligation in accordance with the payer -provider network agreement. You might want to ask for a prior authorization number just for added measure.   Shame this is something we shouldn’t have to worry about! 

I thought I still had the out of pocket to pay. 🤷‍♀️ illl call and check though. 

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"Out of pocket"--do you mean a deductible?  

Geeze, almost two weeks between scan and appointment seems harsh.  I think a week is the longest I've had to wait.

Hang in--I'm betting it will be good news.

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21 minutes ago, LexieCat said:

"Out of pocket"--do you mean a deductible?  

Geeze, almost two weeks between scan and appointment seems harsh.  I think a week is the longest I've had to wait.

Hang in--I'm betting it will be good news.

Thanks Curt!

Lexi my deductible is 700 but I have to pay a % up to $3100 out of pocket a year. It could be a lot worse so I’m not going to complain. 

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Gotcha.  Well, I'd sure make an effort to have them cover it--even if you wind up having to use your out-of-pocket one way or another, best to spread it out, no?

I'm fortunate--my insurance requires significant outlay only if I go out of network, so I'm a bit spoiled that way and forget momentarily that not everyone's insurance is set up that way.  

But you're right--could be a LOT worse without insurance!

 

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Prayers Paula, I’m sure it is scary but have the faith it will be fine .so my insurance is denying my 3 month Scan 🙄 they said I only need a 6 month scan and I’m not sure what to do ..do I just go pay 1200.00 out of pocket or do I wait for the 6 month? I don’t think I can handle the anxiety of 3 more months, I already think this nodule has grown and I have all of these symptoms..Michelle if my pulm doc calls my insurance and tells them it is necessary will it then be approved ..I need some advice ..thanks friends ❤️

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Hi Lisa-

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! 

Michelle

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My initial PET scan was denied at first.  They said the nodule was too small, it needed to be 1 cm to qualify for a PET.  The doctors were successful in getting it through the peer review process.  

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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 ❤️

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It could be that the insurance company is treating this as a screening CT (which follows a standard protocol, I believe), rather than a diagnostic CT (which may be more of a discretionary call for the doctor).  Just a thought--maybe ask your doctor's office about that possibility.

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11 hours ago, Lisa L said:

Prayers Paula, I’m sure it is scary but have the faith it will be fine .so my insurance is denying my 3 month Scan 🙄 they said I only need a 6 month scan and I’m not sure what to do ..do I just go pay 1200.00 out of pocket or do I wait for the 6 month? I don’t think I can handle the anxiety of 3 more months, I already think this nodule has grown and I have all of these symptoms..Michelle if my pulm doc calls my insurance and tells them it is necessary will it then be approved ..I need some advice ..thanks friends ❤️

Lisa L I would be just like you and knowing me I’d push for it earlier or pay out pocket. 

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Hey guys thanks for the info the pulm doc called my insurance and so I’ll be getting my ct scan April 23, almost 4 months but better then 6.  Don’t mean to be taking over your topic Paula I will be thinking about you Monday ❤️

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Good luck Paula! I didn't realize you had to have a PET...I also thought you were being followed with CT scans.

Ro

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16 hours ago, Roz said:

Good luck Paula! I didn't realize you had to have a PET...I also thought you were being followed with CT scans.

Ro

Thanks Ro, I’m ready to get it done and have the Dr appointment to cover results. No coffee this morning is hard. 

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Paula,

Good Luck!  I will be thinking of you and really hoping for the best news! 

I just got onto the site so have a lot to catch up on... I'm glad I saw your post. I guess I'm confused as to why some people are getting PETS and others (like me!) are getting CT's...

I wish you didn't have to wait so long for the Dr's appointment for results... I've found that is the hardest thing for me to do. Waiting. Yuck.

Sleep well... I'm thinking positive thoughts for you!

Colleen

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