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Tue Sep 25, 2018, 02:36 PM

Insurance company denied the PET scan

so now my doctor is seeking authorization for CAT and bone scans. She wanted the PET because it would tell us everything in one scan; there may be other scans besides CAT and bone I'm going to have to have to get the same information.

So another frustrating wait. And I repeat: BUT I HAVE THE GOLD PLAN!!!

This was especially frustrating because my surgeon's practice has a patient portal online where I can get messages and see test results, etc., and I had a message that the PET had been OK'd and here was my authorization number. But when I called to make the appointment, the scheduler said there was something wrong with the number--wrong prefix or something--and she needed to call my doctor, which she did. The nurse called me with the bad news, and then I called the insurance company to find out why.

Unfortunately, their explanation made sense. They said they would authorize a PET scan after my surgery, if the lymph nodes showed spread. Well, OK. It's just that I've had cancer in my kidney, too, and was told that that was a type of cancer that was likely to pop up elsewhere. I get kidney scans every years, and chest x-rays (the lungs are the favorite spot for the kidney cancer to recur in), so I guess I'm covered.

It just would have been nice to get it all checked at the same time. So I could know.

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Response to cyclonefence (Original post)

Tue Sep 25, 2018, 02:39 PM

1. I'm with you. Get it all done at the same time. That's how I was - just do it all so I could know.

Because the not knowing, for me, was worse than what I was already going through.

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Response to Solly Mack (Reply #1)

Tue Sep 25, 2018, 03:07 PM

3. I don't think enough attention is paid by doctors or insurance companies

to the anxiety caused by the waiting and uncertainty. It would be nice if they could get together sort of a package that was ready for anyone newly diagnosed with cancer, that would guide the patient through exactly what was happening and would automate some of these things we have to wait for.

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Response to cyclonefence (Reply #3)

Tue Sep 25, 2018, 03:12 PM

4. My doctors did that for a lot of things, to their credit - but then they kept saying

but this (bad thing) only happens in less than 1% of cases, so no need to go into it.

Then I hit Bingo! as a less than 1 percenter. I excelled at it.

Which left me waiting and not knowing at several turns.

Excellent insurance, fortunately. I'm grateful for that.

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Response to cyclonefence (Original post)

Tue Sep 25, 2018, 03:01 PM

2. Sorry to hear about your situation

but I think these days were all in the same boat. About a month ago I went to e.r. for chest pain, insurance said they won't pay because I had symptoms for more than 72 hours. I didn't go until I felt pain in my left shoulder and neck. I'm waiting for the answer to the appeal. I asked am I supposed to go every time I feel a little pain just to make sure it's paid?

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Response to cyclonefence (Original post)

Tue Sep 25, 2018, 04:08 PM

5. Something similar

I had a PET scan 3/4 of the way through chemo. Originally the insurance denied it. My doctor called their doctor and found out how to modify the order to get approved. Strangely, they'd only do it if he ordered the MORE expensive procedure. Go figure. Oh, and the co-pay was $2600.

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Response to zipplewrath (Reply #5)

Sat Sep 29, 2018, 09:16 PM

7. My understanding is that they'll pay for the PET scan

if the lymph nodes show cancer cells. $2600! Wow. Both my surgeon and a friend who's a retired radiologist tell me that the same information can be gained from other scans (CAT and bone scans are two of them), so I'm not so bent out of shape over the denial. Until I read your post, my big objection was that there would be a co-pay for each of the multiple scans (I think the CAT was $250) instead of one co-pay for the PET.

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Response to cyclonefence (Original post)

Sat Sep 29, 2018, 04:47 PM

6. You need to make sure they know you are a human, not just a client.

stay strong and be sure to give your caregiver a big hug.

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Response to alfredo (Reply #6)

Sat Sep 29, 2018, 09:17 PM

8. Thank you

Actually, the woman I spoke to at the insurance company couldn't have been nicer. She sounded genuinely upset that my request had been denied, and I ended up sort of comforting her because I knew I could get other scans that would be approved.

My husband gets too many hugs already! --just kidding; he's a peach.

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Response to cyclonefence (Reply #8)

Sun Sep 30, 2018, 11:15 AM

9. Bonding with the voice on the other end really advances your cause.

My wife was my rock. She made sure I made it to and from my chemo and radiation. She steadied me when walking to the Cancer center. She pushed my wheelchair when a cane no longer did the job.

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Response to cyclonefence (Original post)

Fri Oct 5, 2018, 04:10 PM

10. oh dear..i hope this work out for you. Hubby going to urologist next week for..

..two 'worrisome' masses on one of his kidneys. we are both scared to death. Hes got a good job but doesnt get medicare for 6 mos yet.

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Response to samnsara (Reply #10)

Sat Oct 6, 2018, 04:19 PM

11. Good luck to you both

I had kidney cancer in 2014, and it's scary. But the treatment was surgery only, so there's no drawn-out treatment if he has cancer, and if it's like mine.

I'll be holding you in my thoughts.

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