Update on my melanoma treatment.

[fightforfreedom]

There is no update, I have not been treated at all and I have good health insurance.

Fair warning to everyone. This is what I have learned.

Doctors, hospitals and insurance companies play a game of poker with our lives. I need a pet scan before any treatment can begin. My doctor requested a full body pet scan. The so called doctors of the insurance company made a counter offer. It has been stuck in limbo.

When I see my doctor I am going to ask him this question word for word. Don't you know how to play fucking Poker? They are gambling with my life. The insurance company is offering my doctor a cheaper scan, just a head scan. My doctor will probably accept it. When that will happen they cannot tell me.

We have to move to a medicare for all healthcare system. We have to take the profit out of healthcare. If the American people do not understand this, it proves to me again how stupid the American people really are. I am not eligible for medicare yet, I am 63. If I had medicare my scan would have been approved already and my surgery would have been done.

I repeat, I have good health insurance, but it's still insurance, PROFIT.

[fightforfreedom]

1. By the way, this could happen to you.

Don't kid yourself.

[XanaDUer2]

2. Damn straight

I had in situ melanoma. I'm lucky to be alive. They scanned me anyway.

Healthcare in this country is a joke, even with insurance.

Good luck

[senseandsensibility]

3. What is a pet scan?

Thanks for explaining.

[fightforfreedom]

5. It's a full body scan that shows where, if, the melanoma has spread.

This scan tells the doctors what kind of treatment you need. It's the whole ballgame.

[OMGWTF]

19. PET is an acronym for Positron Emission Tomography

[Backseat Driver]

20. This is why one needs to "do your own research"

A laymen's guide just to start: https://en.wikipedia.org/wiki/Positron_emission_tomography

[DarthDem]

4. I'm so sorry and I agree

I trust and hope and pray that you'll be fine, but I am sorry you're having to deal with this nonsense. I agree that MFA appears to be a good option. My very best to you!

[Tetrachloride]

6. i suggest immediate lawyer. make a video, take it to tv station

call in the chips

legislators, medical schools any connection

[fightforfreedom]

9. I have a number for a lawyer.

I will wait just another day until I call them. Man, you would not believe what I told people on the phone today. I was brutal. They will have to bleep out the recordings of my phone calls.

[Quakerfriend]

7. Yes, fff- And, so sorry you are in the middle

of this. I believe it’s criminal that insurance companies are allowed to define patient’s needs!

It must end. Given your diagnosis, it’s only right that you should have your whole body scanned!

[Wicked Blue]

8. Find out what state agency regulates health insurance and complain to them

Going over their heads can be effective

[PlanetBev]

10. Exactly the shit I went through in 2005-2006

They insurance company sent me to a dermatologist for a wide local excision. The pathology showed that the melanoma cells
were too close to the margins. Then they finally sent me to an oncological surgeon, who did the successful surgery and sentinel node biopsy in the hospital. The surgeon was furious that I wasn’t sent to him first and told my family that insurance companies were a bunch of “assholes.” The first surgery cost the insurance company $13,000 and the second one $21,000. They paid double trying to find the cheap way out.

[Blecht]

11. That really sucks

I'd be furious.

I had surgery to remove in situ melanoma in 2011. I spotted it myself, got a referral to a dermatologist, and had my surgery (with a real surgeon) within one month. They got it all.

I'd compare healthcare to craps rather than poker -- it is a crapshoot as to what kind of health insurance you get. I was lucky.

Keep fighting -- never shut up. You are fighting for your life.

[Hassin Bin Sober]

12. Yeah, my partner had a tumor on his pancreas and it took months to get treatment.

Between insurance authorization and scheduling tests and re-scheduling new tests. I was livid: “Take your sweet time, it’s not like it’s cancer or anything!”

I roll my eyes when people say you have to wait for “socialized medicine.” And we have excellent insurance.

[AngryOldDem]

13. Unconscionable.

[Bev54]

14. I know people knock our Canadian system for being slow

and sometimes it is in some places and one of those is cat scans. The thing we don't have to worry about is our care being negotiated with an insurance company. I had a friend who was waiting for a scan and told him for the price he could just get a private scan which was only $500. I would rather we fight to improve our national medical and it is how good your doctor is to get the scan scheduled. You have to lean on them to get the job done sometimes.

[SheltieLover]

15. Can you lean on your doc to get approval?

So sorry this is happening to you!

[doc03]

16. I had ocular melanoma in 2005. That is a tumor on

the retina. I was treated at OSUMC in Columbus. I had good insurance at that time I don't think they missed any tests. I had a radioactive seed placed on my eye for 5 days. I fully recovered and have had no problems for 17 years now. Never paid a dollar for my treatment. I hope things go that well for you.

[AmBlue]

17. Find out what agency in your state regulates health insurance

... like Wicked Blue said above. When my insurance company started playing games with my life and health, I contacted the CFO office here in Florida. They assigned me a caseworker and a case #. By law the insurance company had to provide a response within 3 weeks as to why they were standing in the way of needed care. Like magic, they stopped saying my condition was "pre-existing' (which it never was) and paid for the needed surgery.

All cases worked by our CFO office on behalf of citizens are a matter of public record. Insurance companies don't like that so they work quickly to resolve issues once the state is involved.

[MLAA]

18. Fingers crossed and give 'em hell!

[MontanaMama]

21. If you can, file a complaint with your state insurance commission.

Most states offer the form online. The complaint should simply state what you said in your OP and that the insurance company is denying care recommended by your doctor, a full body PET scan which is the standard of diagnostic care for someone with a life threatening cancer.

I was an insurance biller for a medical practice for 21 years. In my experience, insurance companies and consumer advocate organizations will do whatever it takes to get insurance commission complaints cleared up as soon as possible. I have filed them on behalf of patients and for members of my own family. I've never had one denied and they are quite simple to do. Your physician's notes should be able to verify his/her recommendation for the full body PET scan.

Don't wait!! Once the complaint is filed, you should receive an email stating it has been received and is in process.

Remember...insurance companies do not have your best interests in mind. They have one obligation only and that is to their shareholders.

[druidity33]

25. This should be an OP... it's life-saving info. nt.

[lostnfound]

22. 100% agree. They have surpassed all reasonable boundaries

The goal is to deny, delay, deceive. It’s criminal.

[hamsterjill]

23. You are absolutely correct.

I watched my sister die in 2017 with colon cancer. It was a freaking circus trying to get treatment for her and it is a full time job for someone other than the sick person to stay on hold hours at a time to try to push things along, only to be given some lame, stalling excuse.

People don’t understand this until they or someone in their family experience it. I know that I didn’t.

Call your doctor on a daily basis and call any medical societies in your area. Call local news stations. Get an attorney if at all possible but whatever you do - make it loud and obnoxious because that is all they understand.

[Meowmee]

24. Try to get it through another doctor

Last edited Tue Mar 15, 2022, 06:59 AM - Edit history (1)

Is your doctor an oncologist? Make a complaint and appeal with the insurance, get a lawyer involved. If needed pay for it yourself, researching the cheapest way to do it. Ultimately your treatment may be more expensive due to what they are doing.

Medicare does this kind of thing too, maybe not with scans etc., my father got no wheelchair approved until he had passed. I asked several doctors and finally took him to a wc clinic, numerous forms had to be filled out by doctors etc. they said it would take three months, more like 4-5. We were able to buy a good transport wc ourselves at the start just to be able to get him to doc appointments and around the house. I should have just bought a regular chair myself as well on ebay.