Our health insurance - united health care-says that they require 4 weeks before approving a psma scan. Has anyone else gone through this process of getting insurance approval for the scan?. Why wait 4 weeks?
The bone and ct scans showed uptake on the hip bone at the beginning of March. At March 30 appt psa doubled from 3.46 to over 8. Dr Sartor expects that Mike will need to change treatment soon and may be candidate for either focal radiation if it’s only the one met or possibly lutetium if the psma scan shows more. We would like the scan sooner but hope that waiting an additional two weeks is not significant difference in the long run scheme of things.
At least we survived the bad weather that we drove through on our way back home from the last appointment. Good thoughts to everyone on this forum. You are a source of comfort.
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longleaf
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I have Medicare plus AARP United Healthcare supplement, and they did not hassle me with any wait time for PSMA scan. I'm very glad I gave up my employer sponsored PPO insurance plan and got on Medicare. So sad that most US healthcare depends on a private healthcare insurance industry that makes huge profits by denying citizens the healthcare they need. We've learned nothing from other countries about healthcare for the common man. Voters keep electing Representatives and Senators who care a lot more about campaign donations from private insurance companies than their constituents' health.
That post is not a political debate, but an insight to medical care experience in the noted country. A conversation which directly noted politics, as your post does, is one though...
And besides, I'm trying to understand who exactly put you in charge, to dictate what this site is about! And what may be discussed! Lol... It "IS" a public forum. Lighten up! Hahaha
As for control of both houses of the one branch of Gov't out of three, here in the U.S., apparently, our health care system has developed over a very long period of generations of politicians and those elected representatives, to its current form. And there then, is no attributable way to assign culpability to any "one" group or persons, as such... It "IS" what it is...
To the OP, wow, that's crazy and arbitrary to be told there's a waiting period! I don't see how this cannot be escalated based upon need and necessity. There's a few things to consider... One is the necessity, and if that's a definite, would you do the test regardless of Insurance coverage (out of pocket)? If so, then ask the insurance carrier what happens if you do the test and then submit for reimbursement post test upon the latent approval? Or find out how soon you could get an appointment for the test, then call the carrier and escalate the call to a supervisor and discuss accelerated approval as you have an available schedule for the test... And see how that goes.
I don't understand insurance sometimes, they have these lists, schedules, formularies, etc... But a so call "waiting time" for a test is completely arbitrary and doesn't mean anything to a patient or a provider. The test is either NECESSARY or it isn't! If they are saying it isn't, then they're going to have to show why. But saying it will take this or that long to process an approval is unacceptable (in my opinion).
But to answer your question, no, I've not had to deal with that type of delay. I'm on private insurance though... Not Govt sponsored (yet).
You said: "And besides, I'm trying to understand who exactly put you in charge, to dictate what this site is about! And what may be discussed! Lol... It "IS" a public forum. Lighten up! Hahaha" - well, that's wrong.
This is a privately owned and moderated forum and we're guests here, subject to whatever rules they care to make. I try to follow the owner's rules as a guest in their forum.
Just sayin'.. "Pubic" is vasty overused referring to forums.
We have United Healthcare through my employer. In December 2021, my husband had a PSMA ordered on Monday and the scan was done that Friday. It’s possible there is a longer lead time now, but I would have expected December to have a longer time requirement.
I am just tired of the policies, and administrative bottle-necks we go through to get medical diagnostics and treatment. When we were “young” we never knew so many road-blocks would be issues when we need health care. Yes, there are your good stories and bad stories, but there should not be any bad stories.
My cancer has been progressing, realistically I no longer have the energy (emotionally or physically) to fight the system, and have “that hope” with cancer … recently I have cancelled all my appointments: from years of experience … new treatments, new side-effects, what the doctors want…(insurance) too often I’ve not been able to get.
We don’t know of or had anticipated so many issues until we develop chronic, terminal health issues.
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My goal will be go get through the coming days along this road with my connection to wonderful Pain Management.
(Okay, some days I often have a more positive attitudes.)
My insurance, Blue Cross, wouldn’t approve my PSMA scan until I first had a CT scan. I’ve now had it and it didn’t give much useful information. Now we’re trying again to get the PSMA scan approved. So far it’s delayed me getting the PSMA by about 5 weeks.
So update, turns out it is not United Healthcare taking 4 weeks. But probably combination of pre-approval and maybe where we are in line that is causing the appointment to be scheduled when it is. We have asked about urgency with regard to treatment outcomes and we are 3 weeks out now from appt.
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