I’m irked and will have to follow up with MD who ordered the test. He wanted it from months ago and I wrongly thought he had gotten the requisite approvals for the imaging, which DID reveal something that needs treatment and follow up but just received a written denial of coverage from the company that rules on imaging for my BCBS insurer. 
That really stinks @HImom.
Hope you can appeal (?).
Yes, I hope the ordering doc will help with the appeal, especially since the test turned up something that hadn’t been there in 2011.
What was their justification for denying it? Do they have a better idea of what to do?
I know some insurance companies like to automatically deny things the first time, and you always have to resubmit. Perhaps your doctors request was not convincing enough, and he needs to be more assertive and say whatever the key words are.
Have re-read it and the ct was APPROVED after reconsideration following an initial denial. Sheesh! It really is interfering with the practice of medicine!
Oh my, annoying, but that is good news! They need to deny, deny first.
Well, he is ordering a re-imaging scan in May, so I’m sure he’ll have to submit more paperwork, but at least he can indicate that he wants to be sure he’s keeping an eye on what he found in the February scan. Man, it’s a bear to have to deal with the bureaucracy!
I hope whatever he’s looking at turns out to be no problem. It’s stressful enough with medical issues, without having to worry about the paperwork.
Yea, hopefully, it is just an infection that didn’t resolve as nicely as one would like. Life is full of surprises–nice to just have peace and uneventful times instead of too many challenges.
@HImom Hope the medical issue is resolved for you. Dealing with insurance companies when you have a medical issue and fighting to get the tests you need has got to be difficult. The bureaucracy involved can be staggering. I feel very fortunate that I have never had to do that, having universal care.
In 2008 I discovered a LARGE lump in my breast. (It was 10 cm in diameter when it came out a few weeks later.)
Before the surgeon did the mastectomy, he wanted to know what he was looking at and ordered an MRI.
It was denied. They wouldn’t do it unless they saw the word “cancer” on the report. The mamo and sonogram results indicating the size weren’t enough.
We went back and forth, and eventually I got the MRI.
If it’s something your doctor feels he needs to determine your best course of treatment, be persistant.
I hope you’re feeling better.
Sorry for all this, HImom and best with your follow up. You have spoken about having good insurance, and while ours is “good”, too, the default position seems to be to say no to expensive tests and meds, then require much documentation from the Dr. for appeals. Lots of gate keeping and lost time. Tough if you are navigating big medical stuff on top of it.
Did they say the reason it was denied?
Shows one of the ironies of the whole argument about medical care, without getting into the politics of it, one of the arguments people make against government single payer systems is you have a government bureaucrat deciding what will be covered…have those people ever dealt with an insurance company, where they have incentives to those making decisions to deny care? Who is making the decisions now, doctor and patient, or some clerk at an insurance company who likely doesn’t comprehend what exactly is being ordered and why?
I am glad it worked out for you, the insurance things is both maddening and frustratingly not clear. Get a colonoscopy as a screen, it will be covered 100% on my plan, do it because they suspect something is wrong (ie a stool sample showed something), you can end up paying thousands. Go to an MRI provider that is supposed to be in network, and they file as outside the network, the insurance company answer to you is that is your problem (even after acknowledging they have a contract with the provider, they are in network)…not saying the alternative will be any better, just saying we already are at the mercy of bureaucrats, ones who have incentive to deny care to save the company money…
This thread has piqued my interest. Son’s Dr ordered a CT scan on Monday. The doc’s office called for approval, and sent son to the hospital at the appointed time (after drinking some can of whatever). After the scan, he was told nothing showed up. Son wondered about his insurance covering, and called. The doc’s office said that the insurance company said it would 'be reviewed." Well, why wasn’t any of this said before hand?
Except that this is a specious argument because, as far as tests go, whatever the doctor orders is covered. It isn’t as though every test or procedure has to be approved by a ‘government bureaucrat’.
I have gone through battles with my insurance companies ( after being cancelled by BCBS ) Over whether or not they would pay for procedures recommended by my doctors , amongst other issues with them as well. I wouldn’t want a government employee assessing my medical needs either.
They also currently have docs of wrong specialties second-guessing whether we really need what our specialist docs are ordering! It’s crazy and very inefficient, adding to the workload, especially for solo practitioners.
“Except that this is a specious argument because, as far as tests go, whatever the doctor orders is covered. It isn’t as though every test or procedure has to be approved by a ‘government bureaucrat’.”
It is, but tell that to the people who claim that a single payer system would take away the doctor/patient relationship, etc…in theory, in a single payer system, you would be correct, since the doctor’s would either work for the government or would be covered by government issued insurance payments to their practice, there would be no such confusion. The people who say ‘government bureaucrats’ would get in the way of doctor/patient decisions (anyone remember the ‘death panels’ trumpeted by certain people of somewhat diminished capacity?) has obviously not had much in the way of medical issues recently, it is very, very few people I know who have had treatment who have not had any problems with the insurance companies, who didn’t have to fight to get things covered, didn’t have to spend hours on the phone when the company tries to pull a fast one, or the doctor’s office pulls a fast one, and so forth. The doctors and the insurers play games, and the patients are the one who end up having to dance the tune. At least with the government, in theory I could try and get help through my local congressman or senators, with a private insurance company, state health insurance comissions are absolutely useless.
I just had part of a CT scan denied because the insurance co considered it “experimental.” It is part of a standard CT test when there are lots of loose bodies in the knee. Dr and billing office both said it’s standard of care. Couldn’t get an MRI because of my cardiac hardware, and the total charge of the CT (including denied portion) was less than an MRI, yet the insurance wants to hit me up for the $270. Nope!