Sunday, February 16, 2014

adventures in health insurance

When I got my new job in July, I got new insurance.  For the first time in my adult life, I am not covered by Blue Cross/Blue Shield.  While I know a few people who have had major problems with BC/BS, they never hassled me, even when I went to M. D. Anderson Cancer Center in Houston for treatment of my first recurrence.

But now I don't have BC/BS anymore, and I'm finding out what life is like under Cigna.  Up until now, there haven't been any issues.  Thursday afternoon I got a call from AZ Molecular Imaging, the facility where I'm supposed to get my PET/CT scan, telling me that my pre-certification for the scan was denied.

Friday I spent about an hour on the phone, first with Cigna proper, who had no record of any request. Then back to AZMI, who told me that Cigna contracts out these approvals to a company called Med Solutions.  So then I had to call Med Solutions to find out why the authorization was denied. That's 3 sentences, but it took about 45 minutes.

Med Solutions has a checklist for cases like mine, and since the "negative RAI whole body scan" box could not be checked, they denied the authorization.  They don't know my history of perpetually negative scans, even when I had my recurrence in 2006, even though my doctor included her notes on my case.   My endo doesn't order WBS for me anymore since they are expensive and disruptive, requiring 2 weeks on the low-iodine diet, and if they're always going to be negative anyway, what would be the point? 

The next step is, my endo's office will appeal.  The insurance company has 30 days to respond, which I fully expect them to take, so I'll have this scan pending for another month, at least. If I'm lucky, I'll be able to make some plans for the short-term future by mid-April.

So, for now, I'm just trying to keep this whole "rising tumor marker, need a scan, can't get a scan yet" situation compartmentalized so it doesn't make me crazy.  Some days I'm more successful at that than others.

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