Announcement

Announcement Module
Collapse
No announcement yet.

Problems with CT Scans

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

  • Problems with CT Scans

    Anyone had problems getting your insurance companies to pay for CT scans? I had an RPLND done in late August and my Dr. has requested a CT scan before my November appointment. Blue Cross Blue Shield just sent me a letter stating

    "The history presented of testicular cancer does not demonstrate sufficient medical necessity to justify certification of this examination at this time. There is no evidence of further pertinet history, symptoms, physical findings on abdominal and pelvic examination, and recent imaging and laboratory test results, and treatment with response, that supports this requested examination."

    Dan

  • #2
    Perhaps the note from page TEST-11 of the NCCN guidelines would help: "Patients status post RPLND, a postoperative baseline CT scan is recommended."
    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
      The NCCN guideline TEST-11 also says that CT scans post-RPLND are every 6 months. If BCBS has that programmed into a screening program, they probably think your next scan shouldn't be until February. I hope a quick phone call will clear up the confusion over needing a post-op baseline scan.
      "Statistics are human beings with the tears wiped off" - Paul Brodeur
      Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

      Comment


      • #4
        Originally posted by Paul54 View Post
        The NCCN guideline TEST-11 also says that CT scans post-RPLND are every 6 months.
        It actually says CT scans post-chemotherapy are every six months. The note says only a baseline CT scan is needed after RPLND.
        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


        • #5
          The title of the table says Surveillance After Complete Response to Chemo and/or RPLND. What I'm sayin' is that BCBS may not have gone any further when they programmed their screening tool, and that a call to them will hopefully clear up the denial about the baseline.
          "Statistics are human beings with the tears wiped off" - Paul Brodeur
          Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

          Comment


          • #6
            Originally posted by Paul54 View Post
            The title of the table says Surveillance After Complete Response to Chemo and/or RPLND.
            If you're looking at version v.2.2009, there's a critical footnote: "CT scans apply only to patients treated with chemotherapy. Patients status post RPLND, a postoperative baseline CT scan is recommended." As a general rule, CT scans after RPLND aren't needed, because the odds of abdominal recurrence are so low. Chest x-rays are sufficient.
            Originally posted by Paul54 View Post
            What I'm sayin' is that BCBS may not have gone any further when they programmed their screening tool, and that a call to them will hopefully clear up the denial about the baseline.
            We're on the same page about appealing.
            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


            • #7
              Thanks guys... I'm going to call my Dr to see what he says. Original letter was sent to him. I got the cc over the weekend.

              Dan

              Comment

              Working...
              X