Nov 11, 2010 06:51AM - edited Aug 20, 2013 03:09AM by OneBadBoob
Back in 2007, I was having horrible problems getting my insurer, Healthnet, to cover much of anything, approving the pre-surgical breast MRI, and was being tossed between one "flunkie" and another, no one knew what they were doing.
I think it was someone here on the board who recommended that I demand a Case Manager from Healthnet, which I did.
She was wonderful and really went to bat for me on approvals for Zofran during chemo--originally they only approved 6 pills per month--(she was the one who faxed the form to me that the onc had to fill out in order to have approval for 30 pills per month--how would I have known it was that easy without her help?) and on getting the anestesiologist fees paid--can you believe they actually denied payment when I had a single mast and a TRAM reconstruction--I said what do you people think I should have done--had whisky and bit a bullet?
She was also instrumental in helping to get scans and MRI's approved, and extended visits to the LE therapist for my lymphedema.
There are some little "tricks" as to how doctors have to write up requests for Zofran, Zometa, and some scans/MRI's and she pointed me to a website that clearly stated the whos whats and whys of what they will or will not approve, which I directed my onc's nurse to.
p.s. When they denied my pet/cat scan after chemo because it was scheduled for the same day (they are done in the same machine, for goodness sake!) she told to have my onc fax over a letter that it was medically necessary for me to have them on the same day because of my severe anxiety issues and clastrophobia and I would need to be medicated for these issues, and it would be in my best health interest to have them done on the same day. Well, lo and behold, they approved it.
Not sure what anyone else's experience was, but I felt that this women had the power to move mountains quickly within the Healthnet system.
I would indeed call up her tomorrow if I was having problems getting any treatments approved.
That was just my experience.
The only thing we ever discussed was the denial of Healthnet for tests and drugs ordered by my onc, so I don't have any worries about ending up in my insurance file, since it was already there anyway.
She sure improved my quality of life during some very difficult times!