CT-Pet Scan

AnnC2019

I had a pet ct scan which was ordered with a pretreatment estimate. Now my insurance won't pay the fee for the tracer dye leaving me with a $600 dollar bill. I have BC/BS of NJ but live in MA, so I just learned it goes through MA first. NJ said it was code issue and the Shields MRI said there is only one code A9552 that can be used. The billing office said MA usually covers this and the problem lies with NJ and NJ is saying it is MA You can't have a pet scan without this tracer. Has anyone run into this? They paid the rest of the billed scan and I had already paid my maximum for 2019. How do I fix this? I have to get a 2nd scan in March....

vlnrph

Perhaps the insurance commissioner's office in either or both states could help.

When I had problems several years ago, I filled out a form on line and got almost immediate results. The company involved, from which prior authorization had been received, was refusing to pay. My attempts to work with them directly went nowhere.

Once the government watchdog was made aware of my situation, the bill got paid and a fine was also levied for their slowness in responding to the claim! Don't give up - you deserve to have this taken care of properly.

AnnC2019

Hi Vinrph,

After numerous calls the tracer for the ct/pet scan I had in 2919 was paid. BC/BS of NJ excluded this code up until January 2020. It didn’t make sense because you can’t have the pet scan without the tracer. I was happy to hear this was resolved but there are probably other people that ended up paying this. Thank you for the information.