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Insurance denial of PET/CT scan

Neuroendocrine Tumors (NETs) | Last Active: Oct 18 10:14am | Replies (15)

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@gangcarotid1

I agree with the calling of your state insurance commissioner. We did that when our son had a LaForte osteotomy tied to the malformation of his jaw from cleft lip & palate. The Dr at Mayo also wrote a scathing letter to our insurance company about it being a correction of acongenital defect, not something only cosmetic. When we were denied the second time, I sent a copy of the surgeon's letter to the insurance commission office, and they enlisted their 7 attorneys to fight it. Final recommendation to the insurance company for the bill by the attorneys was to pay the bill in full or they would be in court where the verdict would be that "this family may very well end up w total coverage for life due to the extremely gross emotional harrassment". They paid the entire bill WITHOUT a deductible, Very best wishes to you!

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Also wanted to mention that a new law was subsequently passed in our state that says any insurance company operating in our state will completely cover all surgical correction for congenital birth defects to the satisfaction of the patient(, even regardless of past coverage!) I call it "Michael's Law".