Topic: Insurance refuses Chemoembolization- help!

Forum: Employment, Insurance, and Other Financial Issues — Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Apr 11, 2011 12:05PM

Posted on: Apr 11, 2011 12:05PM

concernedcaregiver wrote:

Hi,

My mom is stage IV with liver mets and has been getting worse lately.  She recently finished her 3rd round of chemo and her doctor sent us to an interventional radiologist to find out about chemoembolization (also known as TACE).  She was told that she was a candidate for the treatment, which would most likely shrink her tumors to a size that would enable her to have eblation.  She was scheduled for the surgery today (Monday, April11th).  

Friday afternoon, we learned that insurance is denying payment for her treatment toting it as "experimental."  This is NOT experimental, and there are patients who have this covered by insurance numerous times.  Does anyone know what we can do about this?  Has anyone had this procedure done and had it covered by insurance?  

Time is of the essence, so any feedback is much appreciated!! Thanks! 

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Apr 22, 2011 11:58AM edwards750 wrote:

concernedcaregiver....bless your heart your mom is lucky to have you. Unfortunately you have to constantly do battle with the insurance companies because experimental seems to be the buzz word they use to deny coverage. I have learned that sometimes it comes down to coding. I have had my dr resubmit a claim and when he recoded it they paid it. Not sure about the treatment you are describing but I would talk to the insurance people at the drs office. They are familiar with how to get a claim paid and they can explain the pitfalls when dealing with the insurance company. Bottom line for them is they dont care where the money comes from just that they get paid. Many people have won appeals with insurance companies. Be persistent. I just had a claim denied for an oncotype test that the insurance approved ahead of time and now are denying it. Makes no sense at all. I have the lab company and the BS office appealing the denial. Regardless, I am not going to pay it because I told them on the front end I would not have the test done unless it was covered by insurance. What is the point of getting it preapproved only to be denied when it came time to pay up. None of us needs this additional grief but it is the way it is now. Good luck...keep us posted.

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