My PET scan was scheduled for Dec 26th. I got a call Dec 21st letting me know my insurance denied the scan. They said it was not medically necessary. My doctor did say this was a possibility but seemed pretty confident he could get it approved. The insurance told me the only way to get the denial reversed was doing a peer to peer review which is where my doctor talks to their doctor. My doctor was out of town until yesterday. Knowing how confident my doctor seemed and after talking to a couple of people that are more knowledgeable than I am about how insurance companies work, I wasn’t too worried about getting an approval.
Oh life. My doctor’s MA called me today and said even after the peer to peer review, my insurance denied the scan. They said I would have to have a whole load of other tests done first before they would approve it. Even after my doctor explained everything and pointed out all the other tests would cost them more money than the PET scan and would not give us the answers we need they still denied it. Their doctor just went down her checklist and would not listen to anything he had to say. This is the first time my doctor has ever had an insurance company deny a service after a peer to peer review and he actually had two. Same insurance company denied another patient of his as well on the same day.
My doctor is going to review everything and see what is the minimal amount of testing I can have done to get the scan approved. More hoops to jump through, more money out of my pocket, more frustration.
