There should be an appeal process and your doc is the one who should intervene. Sometimes it is a matter of providing backup info such as in patient notes or a letter from your doc.
CT Scan Denied
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There should be an appeal process and your doc is the one who should intervene. Sometimes it is a matter of providing backup info such as in patient notes or a letter from your doc.
Tara, I am sorry for you situation. This may not be the best forum for your question, most people here are in the insurance business, not the medical profession. Also, we do not have all the facts as it pertains to your situation.
Ultrasounds tend to be safer for the patient, cost about 1/10th the price, and in many instances have similar efficacy to CT scans. Again, not being a medical practitioner, I am not saying this is why you were denied the exam, just some thoughts. Good luck.
Ultrasounds tend to be safer for the patient, cost about 1/10th the price, and in many instances have similar efficacy to CT scans. Again, not being a medical practitioner, I am not saying this is why you were denied the exam, just some thoughts. Good luck.
Thanks. I am also in the insurance business. I work for Primerica. I am just upset. I have had the ultrasound, and need surgery. The doctor needs better imaging before deciding how to best proceed, but UHC will not authorize, and so I am both in pain and frustrated. I was searching to see if UHC has a history of refusing the CT scans, and it appears that they do.
That's a bit of a leap.
I am not defending UHC nor any other carrier. While the public views carriers as ogre's that delight in denying claims (or potential claims), the truth is they are usually on sound footing when they say no.
Does your doc have a financial interest in the imaging center? Have you considered a 2nd opinion from a different doc?
The doctor (vascular surgeon) has no financial interest in the imaging at the Metrohealth facility in Cleveland. I have spoken to his colleague today who was also shocked by the denial of coverage as my condition is very painful, limits my mobility and is potentially life threatening, visible on an unltrasound. The CT imaging is required for treatment. I have confirmed this with a different surgeon at the Cleveland Clinic. The untrasound does not provide enough detail or explain a mass adjacent to the vein that is also seen on the ultrasound. It does show that vein is enlarged (3x) and is bleeding.
The other thread on this site also mentions UHC as denying what seems to be a much needed CT scan. With the anxiety and waiting that UHC is known for I will be switching provider when it is practical.
The other thread on this site also mentions UHC as denying what seems to be a much needed CT scan. With the anxiety and waiting that UHC is known for I will be switching provider when it is practical.
Switching provider or carrier?
If carrier, why didn't you do that during open enrollment?
Still think having your doc appeal the pre-cert is the best move at this point.
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