On 7/3/2008 CAgirl wrote:
I have had the same health insurance since 1981, they were very generous with me when Thyroid Carcinoma was diagnosed in 1986, paid 100% of partial thyroidectomy, and follow-up with my endocrinologist appointment/labs for 5 years without contest.
Then, in 1991 they gently advised me that my Primary Care Physician could take care of monitoring the lab tests. Funny thing though, while the HMO sounded agreeable to me, they apparently told my primary care doctor that it wasn’t necessary to take the Tg (Thyroglobulin) or TgAb (Antibodies), only the lab work for T3, T4 and TSH needed to be run, as a 5 year survival means "cure".
When finally checked by the original endo, my Thyroglobulin test was 600. Off to emergency high dose Radioactive Iodine ablation I went. Since WBS was not helpful, the Thyroglobulin tests will determine whether I need to have a PET scan to locate any metastases.
Now, after less than a year after ablation and two Tg blood tests, the HMO says I don’t need to be followed by my endocrinologist anymore, and is denying appointment (with only 3 days notice before my appointment date).
What gives? How many of you have had your HMO deny your appointment to your endocrinologist when you are being followed for Follicular Carcinoma recurrence? How did you deal with it? Well, I do know avenues for recourse, but they all take time; any thoughts on a fast solution?
Needless to say, I'm upset about this. Yes, I can go pay my endo out of my own pocket, that's not the point; What if I do need a PET scan to find where the metastases is? Plus the posibility even more medical attention to resolve? This HMO interference is out of line. Am I being overly anxious?
Your HMO is out of line. Once you are in remission you will still need to be checked at least yearly for the rest of your life according to my doctor. I have not had a problem with my group insurance at work, except for my prescription plan CxxxMark. They will not cover the Thyrogen shots needed for the stimulated thyrogolbulin test ~$1700-2000 for two injections. I need to have my doctor educate them and file an appeal. I have been having my doctors office bill it as a medical procedure. I pay AETNA specialty pharmacy and they ship the Thyrogen to the doctors office. I pay the medical co-pay directly to AETNA. My doctor hinted that I may have a problem getting my insurance to pay for a PET scan if needed later, unless everything else is tried and it is a last resort. On my second re-occurence (elevated thyroglobulin) no tumors were found. MRI of neck, CT of head and chest. Rad uptake whole body scan. I will find out in Aug 08 if the second ablation worked by a non stimulated thyroglobulin test and followup late in the year with a stimulated test.