PET scan denails?

GracefulMeadow – My son had a procedure known as chemo-embolization at Johns Hopkins in Baltimore, MD. The day before it was scheduled, I received a call from the scheduler at the hospital saying that his insurance would not pay because it was not an “approved procedure for cholangiocarcinoma.” It’s a long story, but eventually, the doctor said he would do it for free. At the last minute, the insurance company decided they would pay. He had a second chemo-embolization and we had to go through the same thing all over again. When I discussed it with the insurance company, I asked what procedures were approved for cholangiocarcinoma – and they told me, “Well, none, because it is so rare.” I wanted to scream!!! BUT – in the end – they did pay and I know the surgeon had to have many conference calls with them first. It’s just awful what you have to go through, but be persistent and fight – fight – fight! Good luck! (P.S. You have the right to appeal their denial as well — my niece had something denied and appealed three times and finally won)! – Nancy

Hi Gracefulmeadows, crazy, it’s just crazy! Teddy was having PETs 2 times a year for several years and they denied him twice. When the ONC went to battle for him he won. I also have a rare Cancer and need PETs, sometimes twice a year and only had to battle once. More recently my ONC put in a request when I saw him in November, for this month, and I got it, no problem. Teddy was on Cigna I am on Secure Horizons. So answer may be the ONC has to fight for it. At one point when I thought they were really not going to come through I searched for independent places in Phoenix that gave them at a reduced rate and did find one that in the end the charge would be $1600.00 and I was going to make the appointment when the OK came through from CIGNA. Good luck.