After I had my WLE/lymph node removal in February, the dermatologist scheduled me for a PET scan, which thankfully came back clean. Seemed like a pretty logical next step, to see if the cancer had spread to other organs. Well yesterday I got a bill from the radiology company, and the insurer (BCBS) hadn’t picked up any of it (>$6K). I call the radiology company, thinking that they’d forgotten to submit the insurance claim, but they said, no, they’d submitted it, but it had been rejected. So I called BCBS, and they said that, indeed, it had been rejected as an “Experimental/Investigational” procedure and I was responsible for the whole thing. I asked which category they put it in, because I didn’t think there’s anything experimental about PET scans, and yes, it’s investigational in some sense, because they’re trying to see if I have mets on my lungs or elsewhere, but I thought that that was normal procedure after finding cancer in the lymph nodes. The guy on the phone was saying it was experimental, experimental, then investigational, and then finally said he wasn’t sure, but that it’s outside their coverage. After a bit more discussion, he said that I could file an appeal, and told me that I had to get my medical records and some other info and then I could try to appeal their decision.
I guess I could understand an insurance company refusing a PET scan as “unnecessary” if you tried to get one every month or something, but has anyone every had a PET scan refused as “experimental/investigational” for the first one after a melanoma diagnosis? I mean, I didn’t sign myself up for the PET scan. The dermatologist just told me after the operation, “You’ve got melanoma in the lymph nodes; you’ve got to go here for a PET scan”, so I went. Seems bizarre to me on the part of BCBS.
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