I consider myself very lucky that I’ve never had to complain about insurance, until now.
Since BB is an outlier in his efforts to cure the disease, his protocols and testing are more rigorous than many. He uses MRI to track disease eradication, and he uses PET for the same thing as well as to provide measurements for precise bone marrow biopsies called fine needle aspirations.
I’ve just learned that my insurance company has rejected these tests, which means I either have to do without, or go out of pocket for several thousand (!!) dollars. I know this because I found out in arrears that they rejected the last batch and I need to come up with several thousand for that go-round.
It had been a pretty consistent dance over the years. BB orders advanced imaging. Insurance company refuses to approve. Somebody from the clinic does a “peer to peer” review with the insurance company and convinces them. They approve.
This time — and last — they did not approve.
Not sure if that’s because of a change in policy or a change in personnel.
The reality is, whomever is the “peer” on the insurance end of the phone doesn’t know this disease. That’s why they are working as a minor administrative official in an insurance company, effectively stamping forms, instead of practicing medicine and treating disease.
As of now, the plan is go proceed with PET because that will highlight the presence of any lesions and can be used to guide the fine needle aspirations. I may or may not also get limited MRIs of my hip and spine, depending on what the PET says, I guess.
What a pain.
I have — with a smidgen of effort, I must admit — resisted the urge to make any political commentary so I would ask those of you kind enough to comment to also refrain from doing so. :)