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Our insurance company is denying my dad of a necessary scan, how can this happen?

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  • Our insurance company is denying my dad of a necessary scan, how can this happen?

    My dad was recently diagnosed with pancreatic cancer. We've had an emotional rollercoaster ride the past few weeks. At first we were told it was stage 4, meaning it spread to his liver and would soon spread into his blood. After a biopsy of his liver, the suspicious spots they thought were cancer, were not found to be cancer.

    So we had another scan, which pretty much told us the same thing, these spots weren't cancer. But the doctor (who's a very good doctor, one of the best pancreatic cancer specialists in the country) wants to be absolutely certain it's not in his liver. They want to do a PET scan, which from what I understand, monitors the glucose absorbed by certain cells. Cancer uses more glucose, and this is a sure way to determine whether or not it's spread to his liver.

    My father is a wreck. The difference between stage 4 and stage 3 of this particular kind of cancer is huge. And now the insurance company is denying this scan. My brother, who took the call, pretty much got the sense that they are denying the scan because they think my father's case is hopeless and they'd rather not spend the money on it, even though the doctor ordered it.

    Can we fight this? What are we supposed to do? I guess we can pay for it out of pocket but we're already stretched thin.

  • #2
    Damn, hearing crap like that really pisses me off.

    I wish I could offer some advice, but I haven't gone through a similar situation. Maybe the doc can counsel you on how to fight it?

    I hope your dad eventually gets the care he needs.
    Brian

    "it aint nothin' but a jam"
    -Jimi Hendrix 10-10-68

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    • #3
      The worst part is my parents have really good insurance, my mom works at a hospital for christ sakes.

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      • #4
        You can appeal the denial--but be prepared for a rather unpleasant process. Depending on the insurer, it be somewhere along the spectrum between getting a tooth pulled and passing a marble-sized kidney stone.

        This, BTW, is why I considered the Republican line in whole recent health care debate to be a giant pile of bull****************. You think there isn't rationing going on already? You think there aren't "death panels" already?
        Giant KudzuFacebook • SoundCloud"I wear Abercrombie so bïtches know I dominate."

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        • #5
          Call the insurance company and ask for a case manager for your dad. This will be a nurse that will act as a liaison to your father. Then write an appeal for the test, use the proper cpt and dx codes.

          Send it in today because they will take their time getting to it. If that doesn't work then you can tell them that you will talk to your states insurance commissioner. Just keep appealing their decision. Usually if the appeal is reasonable they will reverse the decision. PET scans are horribly expensive.

          Anyways get that case manager, they will be able to help you immensely.

          Good luck man.
          Originally Posted by eloydrummerboy


          Crab_Cake is right









          Originally Posted by sonik


          Age would probably be a factor. I imagine the elderly and very young being much easier to tear into.

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          • #6
            Keep track of all that paperwork. You may need it.

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            • #7
              Call the American Cancer Society. They may be able to help you guys in this situation. They can do a lot of things, ranging from helping you appeal the decision all the way to just arranging for the test to be done, pro bono.

              They helped a ton when my grandma was sick 10 years ago, and even more when my friend's wife had ovarian cancer for the last 13 years or so.
              Originally Posted by Howard Zinn


              If those in charge of our society - politicians, corporate executives, and owners of press and television - can dominate our ideas, they will be secure in their power. They will not need soldiers patrolling the streets. We will control ourselves.



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              • #8
                Sounds like Crab Cake's and ChiRocker's advice is good. Keep all your contacts' names written and a log of all communication with them.

                Best of luck.

                Pancreatic cancer is some serious ****************.

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                • #9
                  We're taking my father to the hospital. He's having an overnight stay. I think they think it's stage 4. I'm really scared, guys.

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                  • #10
                    We're taking my father to the hospital. He's having an overnight stay. I think they think it's stage 4. I'm really scared, guys.



                    Thats hard. Much mojo for you and your family.

                    My Dad was diagnosed stage 4 lived another 10 months. We have a student;s mother who was diagnosed stage 4 with another kind of cancer and is still with us a year and a half later. Fighting for good treatment and giving your dad a positive environment no matter how scared you are goes a long way.
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                    • #11
                      We're taking my father to the hospital. He's having an overnight stay. I think they think it's stage 4. I'm really scared, guys.




                      I'm sending some prayers your way, man.
                      Originally Posted by Howard Zinn


                      If those in charge of our society - politicians, corporate executives, and owners of press and television - can dominate our ideas, they will be secure in their power. They will not need soldiers patrolling the streets. We will control ourselves.



                      Good trades with: tincob, dwerlin, ute, budkingston, birdienumnum, trevorus

                      Check out my band! www.TRArock.com

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                      • #12
                        Contact the physician who is in charge of your father. Ask him if there is anything he can do to help with dealing with the insurance co. The physician has more clout with the insurance co than you do.

                        In dealing with an insurance co:

                        be polite, calm and emotionless
                        use the proper medical terms
                        keep a written record of all phone conversations
                        get names and phone numbers/extensions of who you talk to
                        recording the phone conversation is illegal but a good idea.



                        You will want to find out who or what entity made the decision, why they made it, and how to appeal the decision.

                        Good luck and I hope your dad pulls through.

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                        • #13
                          Some good suggestions here. An appeal is a good idea, as is having the doctor get involved. Insurance companies owe it to their stockholders to make money; they do that by controlling how much they spend. I have frequent battles with insurance companies trying to help people get the services they need.

                          I will keep you and my family in my thoughts. Keep looking up, bro.
                          __________________________
                          Gary Blanchard
                          www.garyblanchard.info

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                          • #14
                            That's some bull****************. I'm so sorry, man.

                            What pisses me off: all the people that are SOOOOO opposed to healthcare reform.
                            I made the mistake of including the name of the band I was in at the time I started my account here, but a lot of my friends really do call me "gibby"...
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                            • #15
                              Obama stop having your minions posting this crap in here to get your health bill passed!

                              Sorry to hear that. I'd mention the fact that if it turns out he does have cancer and his health turns for the worse and it could have been averted had he had the scan, you will be notifying an attorney specializing in dealing with large insurance companies. You will get your scan granted.
                              "All tyranny needs to gain a foothold is for people of good conscience to remain silent" - Thomas Jefferson

                              "There are two types of people - those that come into a room and say, 'Well, here I am!' and those who come in and say, 'Ah, there you are.' - Frederick L Collins

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