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No, doctor would like to do PET scan first. I was told we were going to be doing a “lower anterior resection.” PET scan was denied by insurance (not sure why. Waiting to hear back.

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Replies to "No, doctor would like to do PET scan first. I was told we were going to..."

@4237220 it’s good to know it was caught early.
Regarding the insurance denial, It’s not unusual for insurers to deny some claims or say they won’t cover a test, procedure, or service that doctors may order. You can appeal many types of health insurance decisions – sometimes it is possible to appeal even things that are written into your health plan’s contract. If the insurer denies a procedure, it must explain to you your right to appeal the decision. If you ask for it, they must give you all the information about the decision. You can ask for this information from a customer service representative or case manager at your insurance company before you make a formal appeal. You can appeal the decision with a copy of the denial letter and your doctor's explanation, along with any other written information that supports using the test or treatment that has been denied. Sometimes the test or service will only need to be “coded” differently. If it still denied, Request a written response. (Keep the originals of all the letters you get; your doctor’s team may be able to help you make copies if you need them.)
Keep a record of dates, names, and conversations you have about the denial.
Formally appeal the denial in writing, explaining why you think the procedure should Be approved.
Get help from the consumer services division of your state insurance department or commission.

It’s a process but it’s something to consider for
You need certain procedures to confirm a diagnosis and move forward with treatment.

I hope this helps and my prayers are with you.