• Registered: Thu, 19 Feb 2009
  • Posts: 87

Topic: If you have Blue Cross and Blue Shield Please read this.

I am looking for anyone who has BCBS. Need to know if they have ever paid for one of your PET scans.

We have just had a claim denied saying this is experimental or investigational.

Thanks. I am just so upset right now with all the medical bills and this for a person who had paid health insurance premiums for over 25 years. I can not imagine what those with no insurance are going through. 

Maybe I just need to get divorced and go on Medicaid.


Jeez..........

  • Lainy
  • Lainy
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  • From: Phoenix AZ
  • Registered: Fri, 13 Jan 2006
  • Posts: 8,315

Re: If you have Blue Cross and Blue Shield Please read this.

Hi Jill, we don't have that insurance BUT for Teddy's PET in December all of a sudden his Insurance Company denied us so I got on the Internet and found a Company here in Phoenix that does nothing but PET Scans. They wanted 1900.00 then they had a company that would pay a couple hundred toward it and the PET would have cost us 1,400.00.  While not the same as having insurance cover it with a co-pay, it was not as bad as the hospitals charge.
Long story short...the Radiologist came through and fought for us and the Insurance approved the scan at the last minute. Ask your ONC or Radiologist if they will intervene. If not see if there is a PET Scan office where you live.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.
  • Registered: Wed, 07 Apr 2010
  • Posts: 73

Re: If you have Blue Cross and Blue Shield Please read this.

Jill--I have Blue Cross/Blue Shield of Kansas now called Anthem.  They've paid for everything so far, but I don't think they've processed a PET scan yet.  I'll be re-checking my bills in a few days.  Will post more as I learn what is up.  By the way, I'll be giving up BCBs 8/31 when my Cobra runs out.  I'll be forced to go onto Medicaid in one of the worst states for Medicaid coverage.  And I won't be allowed to go out of state for care.  Both the old and new healthcare systems seem to omit me in their plans.  God will help anyway!

  • From: South Elgin, IL (near Chicago)
  • Registered: Fri, 12 Mar 2010
  • Posts: 303

Re: If you have Blue Cross and Blue Shield Please read this.

Hi Jill,

I have BCBS "HMO" that HAS paid for a PET scan.  That might make the difference.  Do you have a PPO or an HMO?  My BCBS is in Illinois also.  That ALSO may make a difference.  My insurance has been pretty good "so far" with covering all the tests that I've had.  Fortunately, I had the insurance coverage BEFORE my diagnosis as I've heard that getting coverage after a diagnosis can be difficult. 

Keep up the fight for coverage.  Good luck.

Linda Z.

"Life is not about waiting for the storms to pass...
it's about learning how to dance in the rain."
  • debrah
  • Senior Member
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  • From: Massachusetts
  • Registered: Tue, 29 Apr 2008
  • Posts: 116

Re: If you have Blue Cross and Blue Shield Please read this.

Hi Jill,  I have BCBS and have has many scans including several PET scans that were fully covered no questions asked.  I wish you lots of luck...fighting back helps..not that you need that on top of everything else.  Wishing you the best. deb

  • Registered: Thu, 19 Feb 2009
  • Posts: 87

Re: If you have Blue Cross and Blue Shield Please read this.

Thanks to all that have responded here. I am getting all the paperwork together right now to send into the state insurance commission.

Oh, and someone ask if my plan was hmo or ppo, it is a ppo.

  • Lainy
  • Lainy
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  • From: Phoenix AZ
  • Registered: Fri, 13 Jan 2006
  • Posts: 8,315

Re: If you have Blue Cross and Blue Shield Please read this.

Jill...I cannot resist this...but instead of a PPO should it not be POOP!~

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.
  • Registered: Thu, 19 Feb 2009
  • Posts: 87

Re: If you have Blue Cross and Blue Shield Please read this.

Lainy wrote:

Jill...I cannot resist this...but instead of a PPO should it not be POOP!~

HA HA HA! Lainy, I happen to agree with your assessment!

  • Registered: Wed, 01 Jul 2009
  • Posts: 168

Re: If you have Blue Cross and Blue Shield Please read this.

Jill,
Our case was different. My mom was on medicare and they paid for everyhting UNTIL she was officially diagnosed with CC. Then when she was admitted into the Mayo protocol for transplant medicaid would not pay because they said  it was experimental. BCBS was her second FULL policy ( not supplemental) and we were so lucky that they picked up her 450K bill for chemo, brachytherapy, dozens of CT scans ( never had a PET) and live donor transplant from my brother. Of course she will be on meds the rest of her life too. So in our case, medicare was the problem and BCBS helped save the day.. best of luck
ashley

  • Registered: Thu, 19 Feb 2009
  • Posts: 87

Re: If you have Blue Cross and Blue Shield Please read this.

Updating with what little info I have.
I have yet to hear from insurance commissioner, however, I did get a letter from BCBS stating they were reopening the claim! Thats all I got for now!

  • Lainy
  • Lainy
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  • From: Phoenix AZ
  • Registered: Fri, 13 Jan 2006
  • Posts: 8,315

Re: If you have Blue Cross and Blue Shield Please read this.

Hi Jill. Well, that is something! Maybe you got your foot in the door now? I will keep thinking positive thoughts!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.
  • Registered: Wed, 07 Apr 2010
  • Posts: 73

Re: If you have Blue Cross and Blue Shield Please read this.

Just Jill--I do apologize sincerely for the delay in getting back to you about Blue Cross/ Blue Shield.  Between chemo fog and my own challenges, I've mentally set aside your situation.  I am terribly disorganized when it comes to medical bills--there are stacks and stacks--am it isn't yet getting better.  When I can make myself get into the pile, then I'll be able to get more information to you.  I am so very sorry to have been unable to help you yet.

  • Registered: Wed, 07 Apr 2010
  • Posts: 73

Re: If you have Blue Cross and Blue Shield Please read this.

Jill-

FINALLY, I can say that I appear not to have had any PET scans, so Blue Cross/Shield didn't need to pay.  Now I am beginnning to deal with Medicaid, and that is a new challenge, as my COBRA Blue Cross/Shield expires 8/1/2010.

Hope you are doing well. 

PS: I appear to have had CT, MRI, MRCP, and Ultrasound.

  • Registered: Thu, 19 Feb 2009
  • Posts: 87

Re: If you have Blue Cross and Blue Shield Please read this.

After turning this over to our state insurance comm. the only thing I have heard is that they changed the status from denied, to pending. They are telling them that it was a mistake to send out the letters, although there were many of them, saying denied. They are now pending, waiting on medical records. I am sure this is a delay tactic, when appeals run out, they will again be denied.

However, my decision to have them at OU medical Center in OKC, has worked out in my favor as they are a preferred provider and due to the contract between them, bcbs and OU med center, the Med center has to accept what BCBS sends. If they send nothing, they can not then, sue me for the unpaid portion.  This is per a rep from BCBS.

To be continued, I am sure.

  • From: Wisconsin
  • Registered: Sun, 07 Sep 2008
  • Posts: 1,996

Re: If you have Blue Cross and Blue Shield Please read this.

It more than likely is a delaying tactic and at this point pending would mean you have a 50/50 chance of approval, however, I think you are right that the decision you made puts you in a better position.  Hope it all goes well.

Darla

"One Day At A Time"
  • Registered: Thu, 07 Jan 2010
  • Posts: 113

Re: If you have Blue Cross and Blue Shield Please read this.

Just-Jill,

I may not be much help.  I have Medicare as my primary and BC (Anthem) is the secondary.  I have a PPO and it is costly, but so far, I haven't had too much trouble with them paying for my scans which has included a PET.
Sorry, you having trouble with the insurance for you do not need more stress.

Theresa

  • Registered: Thu, 19 Feb 2009
  • Posts: 87

Re: If you have Blue Cross and Blue Shield Please read this.

I got the final notice on this claim from BCBS of Ok. The denial stands. They included a whole list of cancers that the pet scan is considered appropriate for, however, this cancer is NOT included.

18 Reply by slittle1127 (edited by slittle1127 Sat, 08 Jan 2011 01:09:48)

  • Registered: Sun, 01 Aug 2010
  • Posts: 493

Re: If you have Blue Cross and Blue Shield Please read this.

So, we struggle with this awful cancer and we can't get medical exams or tests covered by insurance. It's really not right. I'd continue to appeal to the state insurance commisioner. Why should you be discriminated against if the doctor feels the test would provide information he needs to make decisions regarding treatment for you? They don't know much about this cancer, but they DO know that they don't cover this test for this cancer. What a system. UGH! I get so frustrated. Please keep us updated.

  • MEA
  • New Member
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  • From: Massachusetts
  • Registered: Fri, 17 Apr 2009
  • Posts: 4

Re: If you have Blue Cross and Blue Shield Please read this.

A year ago I was changed from Harvard Pilgrim insurance which always covered whatever my doctors ordered to BCBS PPO which has denied coverage for prescriptions (usually they allow me about 1/4 of the number of pills prescribed), blood tests, and treatments (Cyberknife and RFA).  My Onc and I decided to wait on the procedure and he will battle BCBS for me when we feel it's time.  I hate BCBS (blue cross bull shit), we shouldn't have to fight with for-profit companies, we're all dealing with enough already.  I will suggest you ask your Onc to try to get BCBS to cover it for you.
Good luck.
Mary

  • From: Iowa
  • Registered: Mon, 15 Feb 2010
  • Posts: 373

Re: If you have Blue Cross and Blue Shield Please read this.

I understand the hassle of insurance coverage.  My secondary coverage is with United Health Care.  They stall, stall and have outright lied to me - saying something is covered when they later deny.  I think UHC would be fine for in network coverage.   Fortunately my primary coverage is BCBS (an HMO).  I have to have referrals from them every six months to go to Mayo, but they have continually approved the referrals.  BCBS has been excellent coverage for me, and they are always so polite when I call them.  UHC usually has me in tears by the time I'm done talking to them.

  • From: Canton, Georgia
  • Registered: Sat, 30 Aug 2008
  • Posts: 146

Re: If you have Blue Cross and Blue Shield Please read this.

Jill - I have BCBS Open Access.  I was originally denied my first PET scan so the doctor had to do a peer to peer review with the BCBS doctor, then jump thru some more hoops but eventually he was able to convince BCBS it was necessary.  I don't know exactly what he said to them but perhaps you can ask your doctor to jump thru hoops too.  I have had a mostly positive experience with BCBS.

- Suzanne
  • debrah
  • Senior Member
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  • From: Massachusetts
  • Registered: Tue, 29 Apr 2008
  • Posts: 116

Re: If you have Blue Cross and Blue Shield Please read this.

I have BCBS and have had it for years.   I have NEVER had to pay for any scans!   The only money I pay is for $15 co- payments.  Good luck and be persistent eventually someone will wake up and smell the roses smile

  • From: Wilmington, DE
  • Registered: Sun, 31 Oct 2010
  • Posts: 65

Re: If you have Blue Cross and Blue Shield Please read this.

Hi Everyone,
I have BC/BS of DE traditional insurance. They are denying the need for a PET scan. Has BC/BS paid for PET scans? Please let me know those of you who have BC/BS.  Thanks, Johanna

  • Lainy
  • Lainy
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  • From: Phoenix AZ
  • Registered: Fri, 13 Jan 2006
  • Posts: 8,315

Re: If you have Blue Cross and Blue Shield Please read this.

Hi Johanna. I have United Healthcare and gladly pay the 250.00 co pay for the PET.  Teddy had Cigna and had the same co-pay. There was one time though that they turned him down until the ONC saved the day and got it. Before I knew it was going to be OK I found that there are now some Stand alone offices that will give the PET for around 1,500. I think this is good to know in case someone feels they cannot have the scan through insurance. I just Googled PET SCANS Phoenix and found them.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.
  • From: Wilmington, DE
  • Registered: Sun, 31 Oct 2010
  • Posts: 65

Re: If you have Blue Cross and Blue Shield Please read this.

Thank you Lainy. I will pay for it if I have to-it is my life. You are always there for everyone-it is so much appreciated. Thank you, Johanna