"My Health Insurance Company Is Risking My Life"

[woodsprite]

5. I'm going through something similar right now.

Evicore (the approval/auditing company that BC/BS goes through denies any scans for endometrial cancer followups. They cover a CA125 blood test every 3 mo, but that isn’t a reliable test for or even a marker for many types of endo cancer.

My urologist just had to back off in a test that he ordered because they told him endo cancer patients don’t need to do comparison CT urogram (w/ and w/o contrast). The uro wasn’t evaluating my endo cancer. He ordered the tests to check on 2 large kidney stones, do a comparison of kidney/bladder flow, and possible kidney damage due to rads that could require stents. Evicore said they would pay for one, not both.

Due to seeing an enlarged lymph node which is in an inoperable, unbiopsiable area, my onco is going to try to order a PET scan but doesn’t know if he can get it approved. If not, he said he’d order another CT scan in 3 mo. If it’s bigger, we’ll start Keytruda. If it’s the same or smaller, we’ll scan again in another 3 mo. Since Evicore says endo cancer doesn’t require scans, I’m expecting denial and having to fight for the test.