[Christa's Mom]

Out-of-network coverage issue (PET scan)

by Christa's Mom on Sun Dec 20, 2015 1:17 pm

Hoping someone else has experienced this and can give me some advice.

EJs insurance is through his company, which is headquartered in Albany, New York. EJ works in Washington, DC, but gets coverage because of the plan's out-of-network policy, which allows him to go to any Blue Cross / Blue Shield provider. However, for some strange reason, this doesn't apply to PET scans.

For his last PET scan, he received preliminary approval from the insurance company, but then had the claim denied. Now he needs to have another PET scan and, although he has again received preliminary approval, he's also been told it will more than likely be denied when the bill is actually submitted because of the out-of-network policy regarding PET scans.

Here is the strange part: If he were to travel to New York, he would be able to have the PET scan, no problem!

Has anyone else experienced this with their employee-sponsored healthcare? I find it hard to believe that in large companies, the employees who work at a headquarters location get better healthcare than those in other offices!

Thanks!

Lyn

[Stann]

Re: Out-of-network coverage issue (PET scan)

by Stann on Mon Dec 21, 2015 7:52 pm

I just had my PET scan denied, although they approved two earlier PET scans a few years ago. Since I'm relapsing, it seems to me that a PET scan is an important tool.

The doc is going to ask for a full-body MRI and is pretty sure they'll approve of it.