F18 bone scan - insurance and a bit of irony

Today I received the usual bills, etc... in the mail along with 2 interesting things that were PC related.  The first was an 8 page promotional booklet from one of our local hospitals.  On the front cover was a picture of a runner and the title of one of their articles, "Faster, Clearer, Better Imaging for Prostate Cancer".  That sparked my interest so I open it up to the article and it is all about the F18 Sodium PET/CT Bone Scan.  It talks about how it provides increased sensitivity compared to the traditional bone scan and that they offer it, even a place where one can call to schedule it.

Now the ironic part of my mail day.  After reading the article, I picked up the next piece of mail and it was from my insurance company.  Here it was a letter saying that my insurance company has denied a request from Dr. Myers to get the F18 scan.  They classify it as not medically necessary and appropriate.  They go on to say that this scan meets the definition of Investigational or Experimental and therefore cannot be authorized at this time....and some more blah blah blah.

What's funny is that more and more hospitals are starting to adopt this type of bone scan, yet they deny it.  Even more interesting, this same insurance company had no problem the first time I got an F18 bone scan done.

There is an appeal process and Myers and I will down that road I'm sure, but it gets exhausting sometimes trying to get things approved, or when they don't pay for something - fight for that, fight for this....It's bad enough we have to deal with this disease, but to battle with insurance companies gets old. 

I'm more amused that both of those items were side by side in the mailbox. 

 

when I read this, it reminds me of living1963's posts regarding Provenge battle. We need to take David's stand and not accept their status quo. I read David's "fall" post and was very moved, this is survival, this is what inspires me when I need it, this is why I enjoy reading all of your posts, for encouragement. Together we stand, Divided we fall. Don't take no for an answer. Fight!

Ok, so I'm working on my appeal for the scan.  They say in their denial that the test is considered experimental.

Does anyone have any good info to show that the F18 has been approved by the FDA, it's growing acceptance as a standard scan for PC at hospitals across the country, and that it is not experimental?

Any documentation or links would be helpful.

Thanks

My insurance BCBS of Alabama denied me the chance to treat my PC with PBRT as they considered it also experimental even though it has been around longer than the Davinci Robot. BCBS will cover the Proton RT in states like Texas where they have Proton centers like MD Anderson. I guess PBRT is only experimental in Alabama. What it all comes down to is cost and how much the insurance company has to pay. The Hospital part of my RALP was billed to BCBS for $58,000 and the insurance's agreed upon payment was only $8500 plus my $250 one night room deductible. BCBS also made going to a very reputable RT PC clinic for BT in Atlanta impossible by calling them out of network even though BCBS of Georgia considered them in network. In my state any man with BCBS and PC, surgery is the forced upon treatment of choice because it is so much less cost to the insurance company. I suspect this is why your insurance is not covering the F18 scans as they must cost considerably more than the old scan technology and the insurance company gets off the hook by calling it experimental. I hope you have success fighting the insurance beast.

Terry

terry:

shows you how very different insurance laws must be state by state. BCBS here in SC back in 2008, pre-approved my primary treatment with the following choices equally: open surgery, robotic surgery, conventional radiation, seed radiation, and cyro???? (can't remember the spelling). so that gave me in theory at least 5 primary choices. they left the choice to my doctor and i.

david

Terry, wouldn't beat yourself up about your "alone" days or pre-HW days. I think most men don't know about places like or similar to HW, and have to make those tough primary treatment decisions on their own, often with only the most minimal of investigation and research. I feel I made the best descision for me at the time, based on what I did know. Knowing now what I know, there would have been a few differences, though I can't prove any of the changes ultimately would have changed my outcome.

david

SpecialLady,

I used some of those links.  Thanks.

We'll see what happens.

Jerry L.