If you have Blue Cross and Blue Shield Please read this.
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Thank you Lainy. I will pay for it if I have to-it is my life. You are always there for everyone-it is so much appreciated. Thank you, Johanna
Hi Johanna. I have United Healthcare and gladly pay the 250.00 co pay for the PET. Teddy had Cigna and had the same co-pay. There was one time though that they turned him down until the ONC saved the day and got it. Before I knew it was going to be OK I found that there are now some Stand alone offices that will give the PET for around 1,500. I think this is good to know in case someone feels they cannot have the scan through insurance. I just Googled PET SCANS Phoenix and found them.
Hi Everyone,
I have BC/BS of DE traditional insurance. They are denying the need for a PET scan. Has BC/BS paid for PET scans? Please let me know those of you who have BC/BS. Thanks, JohannaI have BCBS and have had it for years. I have NEVER had to pay for any scans! The only money I pay is for $15 co- payments. Good luck and be persistent eventually someone will wake up and smell the roses
Jill – I have BCBS Open Access. I was originally denied my first PET scan so the doctor had to do a peer to peer review with the BCBS doctor, then jump thru some more hoops but eventually he was able to convince BCBS it was necessary. I don’t know exactly what he said to them but perhaps you can ask your doctor to jump thru hoops too. I have had a mostly positive experience with BCBS.
I understand the hassle of insurance coverage. My secondary coverage is with United Health Care. They stall, stall and have outright lied to me – saying something is covered when they later deny. I think UHC would be fine for in network coverage. Fortunately my primary coverage is BCBS (an HMO). I have to have referrals from them every six months to go to Mayo, but they have continually approved the referrals. BCBS has been excellent coverage for me, and they are always so polite when I call them. UHC usually has me in tears by the time I’m done talking to them.
A year ago I was changed from Harvard Pilgrim insurance which always covered whatever my doctors ordered to BCBS PPO which has denied coverage for prescriptions (usually they allow me about 1/4 of the number of pills prescribed), blood tests, and treatments (Cyberknife and RFA). My Onc and I decided to wait on the procedure and he will battle BCBS for me when we feel it’s time. I hate BCBS (blue cross bull shit), we shouldn’t have to fight with for-profit companies, we’re all dealing with enough already. I will suggest you ask your Onc to try to get BCBS to cover it for you.
Good luck.
MarySo, we struggle with this awful cancer and we can’t get medical exams or tests covered by insurance. It’s really not right. I’d continue to appeal to the state insurance commisioner. Why should you be discriminated against if the doctor feels the test would provide information he needs to make decisions regarding treatment for you? They don’t know much about this cancer, but they DO know that they don’t cover this test for this cancer. What a system. UGH! I get so frustrated. Please keep us updated.
I got the final notice on this claim from BCBS of Ok. The denial stands. They included a whole list of cancers that the pet scan is considered appropriate for, however, this cancer is NOT included.
Just-Jill,
I may not be much help. I have Medicare as my primary and BC (Anthem) is the secondary. I have a PPO and it is costly, but so far, I haven’t had too much trouble with them paying for my scans which has included a PET.
Sorry, you having trouble with the insurance for you do not need more stress.Theresa
It more than likely is a delaying tactic and at this point pending would mean you have a 50/50 chance of approval, however, I think you are right that the decision you made puts you in a better position. Hope it all goes well.
Darla
After turning this over to our state insurance comm. the only thing I have heard is that they changed the status from denied, to pending. They are telling them that it was a mistake to send out the letters, although there were many of them, saying denied. They are now pending, waiting on medical records. I am sure this is a delay tactic, when appeals run out, they will again be denied.
However, my decision to have them at OU medical Center in OKC, has worked out in my favor as they are a preferred provider and due to the contract between them, bcbs and OU med center, the Med center has to accept what BCBS sends. If they send nothing, they can not then, sue me for the unpaid portion. This is per a rep from BCBS.
To be continued, I am sure.
Jill-
FINALLY, I can say that I appear not to have had any PET scans, so Blue Cross/Shield didn’t need to pay. Now I am beginnning to deal with Medicaid, and that is a new challenge, as my COBRA Blue Cross/Shield expires 8/1/2010.
Hope you are doing well.
PS: I appear to have had CT, MRI, MRCP, and Ultrasound.
Just Jill–I do apologize sincerely for the delay in getting back to you about Blue Cross/ Blue Shield. Between chemo fog and my own challenges, I’ve mentally set aside your situation. I am terribly disorganized when it comes to medical bills–there are stacks and stacks–am it isn’t yet getting better. When I can make myself get into the pile, then I’ll be able to get more information to you. I am so very sorry to have been unable to help you yet.
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