CancerCompass message board discussion started by 32993299 on 9/14/2006 http://www.cancercompass.com/message-board/message/all,6883,0.htm Tue, 02 Dec 2008 00:00:00 GMT Tue, 02 Dec 2008 00:00:00 GMT http://backend.userland.com/rss RSS.NET: http://www.rssdotnet.com/ I'm retired and I have medicare a & b and aetna. I have been diagnosed with bladder cancer one turmor was removed last Dec. I've had two bladder inspections. The first inspection was clear. The second one showed the formation of another turmor. My Dr ordered a ct scan of the pevic area. The scan showed no additional turmors but did indicate lymph nodes in the abdominal area that are enlarged. A pet scan was requested and medicare refused approval-they stated that pet scans are not used for bladder cancer. The pet scan was to be used to detremine how many lymph modes are enlarged and also is there any evidence of additional turmor activity within the body. Aetna will not provide coverage when medicare does not provide coverage. At this point I'm stuck in neutral-anyone have any advice? Thanks. 32993299 Thu, 14 Sep 2006 00:00:00 GMT it is a PITA to do, but medicare has an appeal process. your doctor needs to write a letter explaining why this test is needed, and submit the letter with an appeal-board form to the appeal board no later than 20 days before the board meets which is 10 times a year. it also may depend on what part of the country you live in because different parts of the country are serviced by different companies for medicare and each has their own set of rules. although your doctor is supposed to be familiar with this process, it is likely he is not. you may have to do all the research on it yourself if you want to get it done quickly. I found some web sites about it at: http://www.medicare.gov/basics/appeals.asp and: http://www.medicare.gov/Basics/forms/default.asp but I did not look at any of the information there. Perhaps start by reading what is there, and if that is not the right stuff, call medicare by phone and tell the the situation and ask them how to find out more information about the current appeal process. Your rejection was made by a computer based on a set of rules developed by an administrator to save money, and possibly reviewed subsequently by a layperson making little more than minimum wage who does not actually even know what a PET scan is. The one piece of good news is that the appeal board is predominantly physicians, almost no administrators. If there is a valid medical reason, which in your case there is, they are extremely likely to approve it. Good luck to you. -Amnia disclaimer: my information about the appeal process is at least 3 years old and based on my memory. things may have changed. medicare by phone can give you the most current information. The phone number for medicare is 1-800-633-4227. call them. PS If the cancer compass people read this, why was my link to "the fall of freddie the leaf" deleted? if you do not wish to answer here, you have my email address. it is not an advertisement for any product. it is a story to help children deal with the subject of death and dying. please respond. Amnia Thu, 14 Sep 2006 00:00:00 GMT If you have to pay yourself here are sites that have dc with deep discounts. Please let us know how this goes for you. I also was denied surgery 3 weeks ago becouse I wanted RC done by I very good surgen but he only does it by robotics. I am apealling. Don Pilot Sat, 16 Sep 2006 00:00:00 GMT