insurance company won't pay for ct scan

[westajul]

Has anyone ever ran into this problem...5 days ago I had an abdomen ct scan and the radiologist found something suspicous and my ob/gyn advised me to contact my gynecological oncologist at MD Anderson. She scheduled me for another Abdomen ct scan. My insurance company won't authorize payment for another ct scan so soon. I did leave a copy of my last ct scan ( 5 days ago) at my gyn. oncologist office. Not sure if she will use the scan from 5 days ago or insist I have another scan done at MD Anderson. Does anyone have any advice on how either to get my gyn. oncologist to accept the previous ct scan or how to get the insurance company to authorize to pay for another scan in less than 1 week? Thanks. Julie

[westajul]

A BIG THANK YOU to everyone who responded to my question. It is so comforting to have a place to go to ask questions and get great advice...especially during these scary unfamiliar times. My gyn. oncologist accepted my previous ct scan since it was less than a week old. Julie

[jlock]

I agree with all the advice given.  Ask for a MRI.  You could ask for a PET,but unless you already have a dx of a certain cancer that the PET has been approved for you could also find yourself not being covered.  Call the PET dept and ask them what is the list of what cancers have been approaved for PET.  I know breast,lungs and colon have been put on the approval list.  I had a PET scan because the ct scan saw nodules on my lungs.  Good luck~~~Joanne

[JC145]

It is not unusual for large medical centers to want scans performed on their machines and read by their radiologists.  Hopefully, the MD will use the existing scan.  Quite often, an MD can speak with an insurance MD to explain the need for a procedure and/or scan and often, it then gets approved.  Good luck ..

Judy C

[alanpvegas]

all insurance companies are different, but also the same.  here are some strategies that work:

1) mostly, you will have some type of 'hmo' part of your plan as well (where you have picked a PCP or primary doctor).  They can push through A LOT since they are part of the wheel so to speak.  Good PCPs can work with your ONC and get it done.

2) Appeal...most people never appeal a 'decision' but the insurance company.  However when appealed, nearly 70 to 90% go in favor of the patient.  You will have to refer to your handbook for information on how to do that.

3) If the oncologist has stated there is something suspicious and they need another ct-scan (for a legit purpose which this is), then the insurance cannot in good faith prevent it since the doctor said it's 'medically necessary'.  Your oncologist should have some sort of 'liaison' person who knows how your insurance company works...

4) I agree with the other post, a PET scan is an option as well...PET shows glucose (sugar) uptake into cancer tumors...if that's what your onc is looking for, might be an option if all else fails....yet....PET is sometimes hard to get approved for since it will cost more than CT.

Good luck and just keep fighting...of course it's a pain to do this while you are in the middle of another battle...but...that is American healthcare for you....hint-hint in November...we need change.

[Sharon2714]

also i had an insurance snafu that delayed my daughters surgery once ... u can call the and a "friendly" representative can decide if they can authorize it ... if not u can appeal as well ... my appeal process took 3 days and amanda had her surgery.  i pray u get what u need
love
sharon

[westajul]

Thanks for the advice...I will speak with my doctor tomorrow and see what she says. julie

[StillFighting]

instead of doing another Ct scan so soon after the last one is there another test they can do? like a pet scan or an mri????