I received the letter about the CT denial from the insurance company today. My doctor had said they were going to appeal it, but who knows if they actually did, so I guess I’ll call tomorrow about it (call the insurance company that is). I would have called tonight, but they closed at 6. It’s for the better I think, since the letter pissed me off and it wouldn’t be fair to take it out on the customer service person since I doubt it’s up to them to decide.
I knew they said it wasn’t medically necessary, but their reasoning annoyed me. It was actually for both the brain and chest (yet another thing the doctor’s office didn’t get right when they told me…they said chest and abdominal). The reasoning for denial of the brain was that their guideline requires “the presence of a headache with neurological deficit or ataxia (difficulty walking), visual impairment, vertigo (dizziness) with a headache or worsening headache”. For the chest it requires “a chest x-ray that leaves questions unanswered and symptoms such as a cough or shortness or breath”. (On a side note, I’m wondering if the chest one would even include the adrenal glands? Did my doctor request a chest when they should have requested abdominal?).
But anyway. While I *do* actually have headaches and dizziness, the doctor may not have mentioned them in light of my more concerning dangerously high blood pressure and heart rate and other more prominant symptoms that fit the symptoms of Cushing’s. And hey, go ahead and x-ray my chest if you want a chest x-ray that doesn’t answer questions such as do I or do I not have a tumor on my adrenal glands.
I don’t actually think they’ll refuse the appeal or anything, but like I said before, this total hassle over dealing with insurance companies is not something sick (or healthy) people should have to go through! We *pay* for this stuff! Why the hell are we paying them if they’re not going to cover the medical care that we need??? I certainly have better uses for my money than to just give it to some insurance company who doesn’t even cover stuff half the time.