Insurance denied request for CAT scan

[maynard]

About 4 years ago, my doctor found pre-cancerous cells in my uterus and I wound up having a total hysterectomy. I had extensive fibroids and endometriosis. My cancer dr. said he had never seen so much endo and fibroids in one person. I had complications and wound up in intensive care for a couple of days. Now, after 4 years, my doctors want to do another CAT scan to make sure everything is OK. Procedure denied. Why? My insurance company decided that since I had the surgery, my pre-cancerous state was taken care of. I now have to
fight for a procedure that has been recommended by my doctor. I happen to have excellent insurance. My insurance company has come between me and my doctor.

Life sucks....even if you have insurance....

[elocs]

1. My goddaughter with schizophrenia used up her insurance company ration in June.

She was 17 and in June her mother's health insurance company declared that she had used up her mental health ration for the year, so no more until next year. Yes, rationing by the insurance companies and it goes on all the time.

[ddeclue]

2. Dear Insured (sic):

We will unfortunately not be able to honor your claim as it seems that your cat is apparently not covered under your policy.

Signed,

Dewey, Cheatham, and Howe Insurers, LLC.

:)

[Suich]

3. That's unreal, maynard!

I hope you're successful in fighting this.

You say you have excellent insurance. If it's not too personal, who's it with?

:hi:

[maynard]

7. It is a co-op

My teacher's union formed a co-op. I have always been able to get any test my doctors order. This was the first time in 20 years I have been denied. My doctors, who have dealt my insurance company, are upset.

[Bozita]

4. The CA AG is investigating large insurers due in part to their 39% denial rate.

When people grow too tired or weak to do battle with them, they win.

[proud patriot]

6. that's good to hear

[proud patriot]

5. Indeed it does

We need our Government to protect us from Insurance Companies .

[Triana]

8. "we don't want no guvmint rationing our health care!"

"we want private, for-profit insurance companies doing it instead!"

Pffft!

There's WAY TOO MUCH stupid in this country.

[unblock]

9. the simple reality is it costs them virtually nothing to attempt a denial

the worst that happens is that you fight it, and they cave. voila, another claim payment deferred a few months.
the best that happens is that you get dicouraged and don't fight it, or otherwise fail to be sufficiently attentive and persistent, and voila, another claim payment avoided entirely.

i often need meds in excess of the arbitrary quantity limits the impose, and my doctor's prescription isn't good enough. they deny it, needing a "letter of medical necessity", which is just a statement from my doctor saying exactly the same damn thing that's on the prescription -- that i do, in fact, need that quantity of that medication.

there's no rhyme or reason to this nonsense other than to throw hurdles in the path of sick people trying to make their way down the road to recovery, because less medication and fewer procedures and later treatment and non-treatment all translate to more profit for the insurance carrier.

they especially love it when they defer things until your employer gets rid of you, or you go into a new year with a fresh deductible, or they otherwise don't have to deal with unhealthy people anymore.

[MercutioATC]

10. You probably don't want to know how little they pay for that CT, either.

I just had a spiral CT as a follow-up for kidney stones I had last year (no recurrence, it was just a 1-year check to be sure). The cost was $1300, but my insurance company paid $280.

I realize that different scans have varying costs, but 300+% markup??