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Insurance denial of PET/CT scan
My husband was diagnosed with grade 1, stage 4 NET in Feb 2024. A PET/CT scan was used for confirmation of this diagnosis. Although the physician thinks this was a necessary scan (and has provided a letter of medical necessity), the insurance company has denied the claim. Meanwhile, the private company who performed the scan has billed us for the full amount ($6000) and send this bill to a collection agency while we were waiting to hear from the insuance appeal. Unfortunately, my husband did sign a waiver before the procedure stating that we have to pay if the insuarance does not. At the time we were anxiously waiting for this diagnosis and did not fully appreciate the implications.
I was wondering if anyone else has expereinced this and how they managed.
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Hello I'm so sorry you are going through this. Part of my job is obtaining prior authorizations for procedures/test, ect. My first question would be, was their an authorization done? Almost all insurance companies require this to be in place before expensive testing is done. If so who took care of it and where is their documentation. Having the prior authorization number and who they spoke to is some firm ammunition when fighting with an insurance company for payment. That being said, as you move forward, question the doctor's office of who ever orders your next testing/treatment if the prior auth is done, and ask for a copy of it. I really hope this helps. Keep pushing!!
When I called the Radiology company a few months back, they said that they contacted the insurance and insurance told them that prior authprozation was not required. I think I will call back and ask for documentation of this conversation with the insurance.
Moving forward, we are more educated now and will ask for authroizations and documentations up front.
Thank you for this comment.
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2 ReactionsHi
I called back the Radiology company and they said they cannot provide me with any documentation/proof that they spoke with the insurance company for prior authorization! They maintain they did call them, but surprisingly, has no proof.
Ask the Radiology Company to provide documentation that they did in fact call the insurance company for prior authorization even though they cannot provide written documentation of the discussion that the insurance company did approve the scan.
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1 ReactionI did, but they said they cannot provide any proof!
Now the Insurance company told us (in writing) that they should have never billed us becasue they have a contract with the insurance company. However, we did sign that waiver...
As of this week, the insurance company have requested Fairfax Radiology to formally appeal to them...sounds like something they were expected to do long before now..
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