I am about 18 months out of treatment for an HPV
caused squamous cell carcinoma cancer (origin occult/BoT). Treatment fine, but I have two issues with my otherwise pretty good insurance.
The last petscan I had at a competing hospital to the one that has been treating my cancer. The one treating me offered the closest petscan 45 minutes from home, whereas the competitor had own about ten minutes from home. I called the company our insurance company uses to interface with BC/BS, and was told that Hospital X's petscan was on BC/BS's list of approved petscans.
Now, 6 months after this scan, I am appealing a bill of $1300 because I did not specifically request a pre-certification from my medical oncologist.
My medical oncologist had sent a "pre-certification" into his system, and somehow it did not follow me to the competing hospital. Having called this interface company to make sure the scan was kosher, one might think they would mention the precert, but they did not (and they do have a record of my call) .
So that's the old one. But my MO just ordered a new one, which would be two years out of treatment (actually 22 mos.), and the insurer denied it, feeling it was not medically necessary.
Does this most recent one seem like overkill, or should I fight the power? I have been getting scoped every couple of months by my E & T or rad doctor.