question

jap62
jap62 Member Posts: 1,385
edited June 2014 in IDC (Invasive Ductal Carcinoma)

hey all,

I just found out my insurance denied my ct & bone scans.  They said since I have no pain in my bones and my alkaline ph look ok they denied it.  So has anyone not have bone [ain & ok ph levels & found afte scans that it had spread?  I say I am stage one but not really sure, my dr said can't stage me till she gets in there and sees it, but going by size, that is why I say 1.  My OC wants me to do chemo first, then surgery, I plan on having adouble mx 

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  • peggy_j
    peggy_j Member Posts: 1,700
    edited February 2012

    I'm not sure when the doctors normally recommend a bone scan. I can appreciate wanting the peace of mind that it hasn't spread. One downside is the scan does emit a fair amount of radiation, so docs might not recommend it (and/or the insurance might not pay) if they think it's unlikely to find anything.  

    FWIW, after I was Dx'd, I had a B-MRI (since I was getting a lumpectomy) and a chest X-ray. (and at my request, a DEXA scan). My SNB surgery showed that the lymph nodes were clear, so I've never had a bone scan. I see that you are HER2+. I wonder if the members in that forum might have a different experience? Good luck. This period after Dx is so hard (trying to learn everything and navigate the medical and insurance systems)

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  • sheila888
    sheila888 Member Posts: 25,634
    edited February 2012

    Dear Jap.....I thought it was routine to have bone scan even if you are stage I

    i'm also HER+ had chest, pelvic, bone and abdominal scans which turned out to be all clear.

    i think maybe you should appeal their decision. After all we all need peace of mind after being DX that the rest of our body is fine.

    Hugs from NY ♥

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  • jap62
    jap62 Member Posts: 1,385
    edited February 2012

    thanks sheila, it is in appeals, have no idea how long that takes, but if I have an agressive type of cancer you would think it should be a no brainer

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  • elimar86861
    elimar86861 Member Posts: 7,416
    edited February 2012

    Since they are giving you the chemo, don't panic about NOT having the scans right away.  Once you have the surgery, you will not only get the actual size of the tumor, but also information on whether they saw LVI (lymphovascular invasion) or if youy had any positive nodes.  If you had either, it would be an indication that your B/C was attempting to spread and I don't think you would have a problem getting the appropriate scan(s) then. 

    My Dx is a little different than yours, but I only had an additional MRI before having surgery, and a bone scan a year afterward because I did have some pain.  Bone scans are relatively cheap, and relatively low radiation in comparison with the other type of scans. 

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  • GramE
    GramE Member Posts: 5,056
    edited February 2012

    jap, I see you in VA - not sure where you are having treatment, but I went to Georgetown Univ Hospital, Ourisman Breast Cancer Center and had MRI, CT Bone scan, DEXA, MUGA, and blood work, all with no denial and prior to first chemo.    

    However, I recently had annual gyn exam, including PAP smear.   Medicare ( I was 65 at the time ) denied payment with something like Not Age appropriate...    The previous PAP was normal, but I had a polyp on my uterus, which was negative.    Since I still have those "body parts" (down there...) doesn't it make sense to get them checked out?

     I wish you well with the appeal.   

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  • jap62
    jap62 Member Posts: 1,385
    edited February 2012

    tx GramE, I am going to go to John Hopkins 4 a second opion, hope they can get me in sooner than later. I will most likey have treatment here near me in NOVA.  Still uneasy about what kind to have, not fond of the chemo route.

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  • peggy_j
    peggy_j Member Posts: 1,700
    edited February 2012
    elimar wrote:

    Bone scans are relatively cheap, and relatively low radiation in comparison with the other type of scans. 

    Thanks for the clarification. I must have confused them with something else (PET scans?)

    Jap62, good luck with your insurance appeal. Hopefully your doc's office knows what to say to get it approved.

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  • bevin
    bevin Member Posts: 1,902
    edited February 2012

    HI Jap, please make sure you file a formal request for review with your insurance and contest opinion. Often they deny the first and then many people dont fight it and they get off scott free.  You can also have your Onco send in a written formal letter stating why you needed it and what results /symptoms promoted the exam. Please fight it , my sis in law works for a major insurance company and she shared that many are paid on appeal.

    Good luck

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  • Wendyspet
    Wendyspet Member Posts: 246
    edited February 2012

    My mo did NOT order any scans for me unless I complained of pain.  I had a ct scan of my head only after I complained of daily headaches (turns out I was just dehydrated during chemo).  I am stage 1, grade 3, er, pr and her2 positive, with a 1.1cm IDC, no nodes. 

    I had surgery first, then chemo, and am still on herceptin and tamoxifin.  I wonder why yours would be opposite?

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  • jap62
    jap62 Member Posts: 1,385
    edited February 2012

    wendy what is your diagnosis?  I think because of the aggressiveness of my dx

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