Announcement

Announcement Module
Collapse
No announcement yet.

Aetna denying claim for ultrasound...

Page Title Module
Move Remove Collapse
X
Conversation Detail Module
Collapse
  • Filter
  • Time
  • Show
Clear All
new posts

  • Aetna denying claim for ultrasound...

    Got an e-mail from Aetna denying my claim for them to cover my ultrasound, which was referred by my Urologist. I even went to the right diagnostic testing facility, not one of my choosing.

    The bill itself is over $600. I obviously am trying to save as much money right now, without knowing exactly what to expect after surgery, etc. I was fortunate enough to acquire insurance a couple weeks before having pain in my testicle, and upon closer inspection, finding the lump + shrinkage.

    Anyone have any ideas? I read that I can try and appeal the claim, which more than likely will get denied, but what have I got to lose? I've done everything by the book, and the ultrasound doppler was necessary in determining what was wrong with my testicle, and lead to diagnoses.

    I haven't even had my surgery yet, so I'm afraid of what might happen then, and even after that.

    Please feel free to chime in.
    Dx: 10/4/10
    Blood Results for tumor markers came back Normal.
    Surgery/ Left I/O: 10/26/10
    11/2/10 - Pathology report came in, 100% seminoma with no evidence of cord invasion. 3 foci, 1.1cm, 0.6cm, and 0.3cm.
    11/3/10 - CT scan of Pelvis and Chest is clear, no abnormalities.
    11/18/10- Surveillance
    10/26/11 - All Clear

  • #2
    Denied on what grounds? By all means appeal, and involve your urologist's office.
    Scott, scott@tc-cancer.com
    right inguinal orchiectomy 6/5/2003 > nonseminoma, stage I > surveillance > L-RPLND 6/24/2005 for recurrence, suspected teratoma but found seminoma, stage II > chylous ascites until 9/2005 > surveillance and "all clear" since


    Your donation funds LIVESTRONG Foundation services for people facing cancer now. Please join me!

    Comment


    • #3
      I agree with Scott. A scrotal ultrasound is the gold standard for diagnosing potential cases of testicular cancer.
      "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
      11.22.06 -Dx the day before Thanksgiving
      12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

      Comment


      • #4
        Talk to the folks behind the reception desk at your uro's office, they know their way around these things better than anyone. If they can't help,file a grievance anyway.

        Dave
        Jan, 1975: Right I/O, followed by RPLND
        Dec, 2009: Left I/O, followed by 3xBEP

        Comment


        • #5
          Anotehr vote to bring this to the attention of your doc's office and get them to fight it. It could be a simple matter of the wrong diagnositc code put on the order for the ultrasound.
          Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

          Comment


          • #6
            This has happened to me multpplie times for blood draws and other screening tests, usually it was because the medical office submitted it incorrectly.

            I went to the insurance area of the hospital and talked with them. They called my insurance company (aetna as well) and they figured it out right away.

            If you haven't already it is wise to create an account and use the aetna navigator on the aetna website to monitor your claims.

            good luck and stay on top of them!
            sigpic
            Diagnosed 4/17/08
            Right orchiectomy 4/18/08
            Pure choriocarcinoma; HCG 715,000; lungs, lymphnodes, liver, and random other places
            4X VIP chemo at IU with Dr. Einhorn 4/25/08-7/4/08
            HCG down to 7.2 10/28/08
            HCG back up to 198 12/29/08
            1 X PVB 1/2/09-1/6/09
            2 X HDC w/ stem cell rescue 2/4/09-3/14/09
            Follow-up with Dr. Einhorn 4/22/09
            HCG 1.2
            3 rounds, 21 days, twice daily, VP-16 50mg 4/24/09-7/10/09

            http://www.caringbridge.org/visit/johncovell

            Comment


            • #7
              So far so good, I got things moving. Haven't been hit up for a dime yet.
              Dx: 10/4/10
              Blood Results for tumor markers came back Normal.
              Surgery/ Left I/O: 10/26/10
              11/2/10 - Pathology report came in, 100% seminoma with no evidence of cord invasion. 3 foci, 1.1cm, 0.6cm, and 0.3cm.
              11/3/10 - CT scan of Pelvis and Chest is clear, no abnormalities.
              11/18/10- Surveillance
              10/26/11 - All Clear

              Comment


              • #8
                Originally posted by FocalPoint View Post
                Got an e-mail from Aetna denying my claim for them to cover my ultrasound, which was referred by my Urologist. I even went to the right diagnostic testing facility, not one of my choosing.
                I agree with the others as far as appealing the claim and getting you urologist's office involved.

                However, don't lose sight of the fact that it is the "Diagnostic Testing Facility" who are owed for the service. My first call would be to them- just tell them you want to help them get paid, and you need their help in navigating and interpreting Aetna's denial. Tell them nicely they will not get paid without Aetna.

                I would also try to get an advocate at Aetna, so that any future precerts and referrals can be done correctly in advance.

                This will work out, don't let it stress you.
                Joe
                Stage III. Embryonal Carcinoma, Mature Teratoma, Choriocarcinoma.
                Diagnosed 4/19/06, Right I/O 4/21/06, RPLND 6/21/06, 4xEP, All Clear 1/29/07, RPLND Incisional Hernia Surgery 11/24/08, Hydrocelectomy and Vasectomy 11/23/09.

                Please see a physician for medical advice!

                My 2013 LiveSTRONG Site
                The 2013 Already Balders

                Comment

                Working...
                X