Insurance Coverage |
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Mary58 
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Joined: Feb 13 2010 Location: Wisconsin Status: Offline Points: 161 |
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 Topic: Insurance CoveragePosted: Aug 23 2011 at 7:06pm |
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Has anyone ever had insurance deny MRI coverage? I received a letter today - saying they were denying it because it was investigational. Gee, I thought it was prudent - considering the TN diagnosis. Well, what is another battle - I hope we can win this one. Mary
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Dx: 1/10, 5mm, 1/28/10 SN negative, lumpectomy, 30 rads, no chemo.
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123Donna
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Joined: Aug 24 2009 Location: St. Louis, MO Status: Offline Points: 13510 |
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Posted: Aug 23 2011 at 8:40pm |
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Mary,
I haven't had any problems with getting MRIs. I hope you can get them to change their minds. Can your onc petition the medical necessity of it? Donna |
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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15 |
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Mary58
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Joined: Feb 13 2010 Location: Wisconsin Status: Offline Points: 161 |
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Posted: Aug 23 2011 at 8:53pm |
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Donna - Will try and let you know. Thanks. |
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Dx: 1/10, 5mm, 1/28/10 SN negative, lumpectomy, 30 rads, no chemo.
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Sethsnana
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Joined: Nov 27 2009 Location: Des Moines, IA Status: Offline Points: 88 |
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Posted: Sep 12 2011 at 7:12pm |
I've had my insurance company refuse a PET scan, but not an MRI.. Insurance companies have absolutely NO clue as to what TNBC is.. It is very frustrating!
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dx 11/09 1.6 cm IDS (nodes clear), lumpectomy and mammosite radiation. ACx4 + 12 weekly treatments of Taxol, started on 1/5/10.
Completed Taxtol 5/19/10. CT scans lungs,liver clear 6/7/10. |
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HappyGoLucky
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Joined: Apr 22 2009 Location: New Jersey Status: Offline Points: 454 |
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Posted: Sep 15 2011 at 12:03pm |
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Hi In NJ we are having difficulty adjusting to mandatory HMO selection.
My onc only accepts Americgroup and all hospitals and others accept Horizon NJ Health. I think I am in trouble. Frankly I am frightened.
Karen
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2/2009 7cm tumor, sent nod. pos. Lumpectomy 3/19/09,a/c dose dense+avastin clinical trial, taxol avastin stopped with pneumonia. 33 Rads 01/2010 ~ reccur 2011 supraclav.and internal mammary nodes. rad
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Barbi
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Joined: Jan 04 2011 Status: Offline Points: 471 |
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Posted: Sep 15 2011 at 11:30pm |
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Let me just say what many of you know. Insurance companies are not your friends. They provide a service you have paid for, but they try their hardest not to pay claims that they might be able to deny. I have worked for insurance companies in a consulting role as a nurse, and had to remind myself on a daily basis of my code of ethics so as not to skew the truth the way they wanted me to. I know how bad this sounds, and I don't mean to make it seem like all they do is scheme to get out of paying, but we sometimes think of them as our saviours, when really we need to be aware of our contracts and understand much more than a layperson should be expected to. So many issues with them.
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10/10,age49,St3,gr3,5+cm,1 node,BRCA-,T+Cisplatin+Rad0001(or placebo),Lump 1+cm,AND 0/15,AC,rads finished 7/6/11.Mets bone, liver,mamm node 8/11,abrax/tigatuzamab failed.Started bicalutamide 11/16/11.
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123Donna
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Joined: Aug 24 2009 Location: St. Louis, MO Status: Offline Points: 13510 |
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Posted: Sep 16 2011 at 8:19am |
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Good point Barbi.
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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15 |
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HappyGoLucky
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Joined: Apr 22 2009 Location: New Jersey Status: Offline Points: 454 |
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Posted: Sep 16 2011 at 8:28am |
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Barbi
I know from what u speak. My daughter in law works for a the largest ins provider. Can't tell u what bonus time is like over there. its a sin.
here in NJ medicare/medicaid has changed to a mandatory hmo. ii have a situation now but chose the most acceptable one to all hospitals and doctors groups. Justing made me so mad that my oncology group doesn't accept any other than amerigroup makes me sick.
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2/2009 7cm tumor, sent nod. pos. Lumpectomy 3/19/09,a/c dose dense+avastin clinical trial, taxol avastin stopped with pneumonia. 33 Rads 01/2010 ~ reccur 2011 supraclav.and internal mammary nodes. rad
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