Staywell insurance (Medicaid) denies treatment

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BeAlive
BeAlive Member Posts: 3
edited April 2017 in Stage IV/Metastatic Breast Cancer ONLY

I was recently diagnosed with stage 4 BC. So far Staywell has denied a PET scan (never had one), referrals to Moffitt, Univ of Miami and the Mayo Clinic, and they're still up in the air about my Ibrance prescription. This really feels like economic discrimination. Does anyone have insurance that works or know a good lawyer in Florida

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  • MmeJ
    MmeJ Member Posts: 167
    edited April 2017

    How were you dx'd Stage 4 without a PET scan?

    By that I mean what processes did you go through to get the dx? Or, who is attempting to refer you to Moffitt, Miami, and Mayo? A "regular" oncologist? S/he would be doing so, I would think, based on the characteristics of your cancer and if that person thinks you need to to go one of the Cadillac places, perhaps s/he can help you get in one of them based on the package of tests you have had and a unique dx. If that's the case, maybe one of them would take you on outside of the Medicaid system and then they can advocate for you and twist Staywell's "arms" once you're under their care.

    Sorry if I'm not being clear with my questions and I apologize for popping in at the Stage IV place. Tenacity's the name of the game with health insurance and I worked in that industry for a very long time.

    Maybe this post should be moved to the Employment, Insurance, etc., thread.

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  • Lauriesh
    Lauriesh Member Posts: 692
    edited April 2017

    I know of other stage 4 women who have never had a pet scan, so I don't think it is that unusual for them not to cover them. Many drs think that a Ct or Ct + bone scan is sufficient Also, as mmej commented, who is referring you to these places for a second opinion? I would call your ins and ask them who would be covered for a second opinion.

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  • Casun19
    Casun19 Member Posts: 111
    edited April 2017

    I am not sure what staywell insurance is but my first pet scan was denied by my insurance because they didn't see that it was medically necessary....I had "great insurance" through my work. Unfortunately some insurance companies will argue with your doctor about what scan should happen first (or at all even at stage 4). I eventually got a CT scan with contrast. And if that was not clear the doctor could order a PET scan. Maybe Ask your doctor if a Ct scan will be sufficient to see results?

    Or if possible switch insurance. I eventually hopped onto my husbands insurance which is an hmo and they didn't seem to bat an eye when approving PET scan or ibrance.

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  • cive
    cive Member Posts: 709
    edited April 2017

    I've never had a pet scan since being diagnosed with mets.  I get CT scans with dye because that is what my insurance (medicare) covers.

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