PET Scan

[Alex_G]

Hello all,

I have no experience how to deal with health insurance and need an advice.
I have blue cross blues shield.I had PET Scan a month ago. BCBS rejected to cover the cost because how they stated: PET Scan is not FDA approved.

I have no idea what to do?

Thanks for advices.

Alex

[Scott]

Your explanation of benefits denying the claim should include a notice about your right to appeal. Start with the 800 number for inquiries. If you need to, get your oncologist's office involved and appeal the claim through BCBS' formal grievance program.

[Alex_G]

Scott,

I already sent letter of necessity from my oncologist to the insurance and was denied again. I'm not sure what documents should I submit for the appeal.
I spoke to oncologist office and they told me that letter of necessity that best what they can do.
I have a friend with cancer problem and she told me that BCBS doesn't pay for PET scan - I'm ready that they are going to deny my appeal also.

Thanks

Alex

[Scott]

Have you started the grievance process yet?

Also, one of the services provided by LIVESTRONG SurvivorCare is to provide advice on "how to manage insurance appeals." You can reach them on the Internet, or M-F from 9:00 a.m. to 5:00 p.m. Eastern time at 1-866-235-7205.

[Alex_G]

Scott,

Thank you for the information.

Alex

[Scott]

Hope it helps, Alex. Let us know.

[rlhawk]

Just keep pushing and they will likely give in. I had to file grievances for both of my PET scans and my insurance company (Blue Shield of Calif.) finally agreed to pay for them.

[kfo9494]

Have you started the grievance process yet?

Also, one of the services provided by LIVESTRONG SurvivorCare is to provide advice on "how to manage insurance appeals." You can reach them on the Internet, or M-F from 9:00 a.m. to 5:00 p.m. Eastern time at 1-866-235-7205.

Scott, thanks for this info.
This site is a must for people that need insurance help.

[Alex_G]

For a 3 month Survivor Care representative tried to resolve this issue but we got another denial letter
Do you think that I should take this case to the attorney? What are my other options?
Thanks for advices in advance.