Paying for Tests before approval

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Analee
Analee Member Posts: 4
edited June 2014 in Employment, Insurance, and Other Financial Issues

Can we pay for the testing before insurance approval..or will they refuse to reimburse if done before approval?    I cant wait around for their approval...we are wasting too much time and if the testing can be paid...then we would be so much closer to start treatment.

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  • Chickadee
    Chickadee Member Posts: 4,467
    edited January 2013

    That's best answered by your individual insurance company. One might and one might not. I looked at your other posts, this is for your daughter. My cancer was also high grade but here I am almost 4 years later hanging in there and doing fine. I was Stage IV from the start. Just try to remember one thing, there is not currently a cure for cancer. So "getting it out" doesn't touch the possibility that cells are circulating elsewhere. You won't know that until she has been thoroughly tested. Try to allow your daughter to trust her medical team. It sounds as if they are giving a good standard of care. It's just the waiting that is awful.



    I know it must be frustrating to wait and wondering what the hell is going on in your body. If its any solace the cancer has been growing for a long time and is not likely to progress largely while waiting for a test schedule. It was 6 weeks before I got my schedule in place because I referred myself to a major cancer center. Waiting was no fun for sure.

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  • itsjustme10
    itsjustme10 Member Posts: 796
    edited January 2013

    From a practical stand point, right now the doctors' offices are fighting with your insurance company for approval.  They know the magic words to say, and have worked with claims reps for years.  If you pay, it's likely that they will stop fighting with them for approval, which means you will have to.  I personally would wait for the approval - it's what I did for myself.

    The extra week or so shouldn't make any difference. 

    Everything seems to be "hurry up and wait".  I can remember flipping out and wanting surgery the day of my diagnosis, but it's not how it works.  They need tests and scans to make sure they know what they're dealing with, and can formulate the best individual treatment plan.  It's frustrating, but in the scheme of things, it's done pretty quickly - it's only slow if it's YOU going through it.

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  • Kelloggs
    Kelloggs Member Posts: 965
    edited January 2013

    I have been a medical billing manager for 25 years, wait for the approval.  I know the wait can seem endless and all you want is to start treatment, but testing, surgery and treatment are super expensive and you do not want to pay out of pocket.  Hang in there, approval will come! {{HUGS}}

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  • Blessings2011
    Blessings2011 Member Posts: 4,276
    edited January 2013

    Hi, Analee - According to Dr. Susan Love's Breast Book, by the time most breast cancers are detectable, they have been in the breast for 8 to 10 YEARS.

    Of course, there are always exceptions with aggressive, fast growing tumors, but generally, the discovery of a breast cancer tumor is not an "emergency" situation. 

    I was diagnosed in September 2011; my surgery was not until December 2011.

    If I recall correctly, it hasn't been that long since your daughter was diagnosed. The doctors are just as eager as you are to get approval for the numerous tests they need to start surgical considerations and the beginning of a treatment plan.

    They don't like to start anything until all the pieces of the puzzle are in place.

    You can definitely check with the insurance clerk who is in charge of submitting forms, but unless there is a problem (like someone forgot to submit something) I would just let the process take place as usual.

    I know how hard this is for you.... big hugs, Mom!!!

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