New Dillema

So now i have a new dillema....

I was scheduled for my MRI today, and i believe it was the endo-coil thing, because they told me light diet the day before and no food 6 hours before the test. It was scheduled for 2PM

So i get a call at about 11:30, telling me that the insurance company declined authorization. (GHI/Emblem). B@stards! They originally requested a call from the doc for more info. He called them late Friday or this morning, not sure, and they came back and said it was unnecessary. 2.8 psa THAT HAS RISEN EACH YEAR THE LAST FOUR YEARS, AND A fREE PSA of 11.

i am not sure if my doc is going to take another run at them. Or if he is going to wait for my PCA3 to come back. Nurse told me she would let the doc know it was declined and then get back to me.

But as of now my only choices are to just forget it and wait 6 months till my next visit, which i am inclined to do since my DRE was normal and the PSA is not that high in absolute terms. Or pay for it myself, which would probably be $1500-$2000.

Any ideas here? I'm so pissed off. (yet relieved at the same time - which i know is weird)

I would reccomend waiting the additional 6 months in your situation, as long as your temperment would work for you with that delay.

david

Pratoman,

I know how upset you are, but I would highly encourage you to take a few deep breaths. Document everything that was said, emails, etc so you have a great audit trail if you need to litigate at some point.

Don't kick the bear this early as you begin the PCa journey. Hopefully you don't see any movement in the next four months.

I have only been dealing with this disease for 28 months. Insurance has been pretty good to cover everything, but once in a while they will kick something out and need some TLC from the oncologists, etc before they approve. Just spent 35k last December, probably spending $100k on intensive radiation and hormone deprivation.

So my advice would be to pick your battles carefully. Cover your tracks so if you every need a great lawyer defending you and your family, you will have great detail to help them. Leave out the emotions, and just use the facts.

Keep your gun powder dry at this point of your journey.

 

I know you guys are giving me good advice, i do tend to fly off the handle when i feel i am wronged in some way. So i will follow your lead, and i guess, let it go. I guess if the Doc thought it was that critical that i get the MRI, he would have either fought them harder, or told me i should consider paying out of pocket to get it done.
Thanks for straightening me out, to both of you. I just hope this is not a sign of things to come, they have never turned me down before for any procedure, test, etc. They were just taken over by Emblem Health about a year ago.
Whatever, I'll take a chill pill, for now.

I agree, 142. Always sounds good to say things like that to get it off your chest, but in our day and age, sure wouldn't want a health insurance company to suddenly find a loop hole to drop a patient's coverage.

david

we be a friendly bunch by nature, you should know that by now, lol. hope we can keep denying you full membership.

david