My husband was diagnosed with Testicular Cancer in April. One testicle was cancerous and was removed - prior to this his tumor markers were normal! He then had a CT scan of the pelvis and abdomen - what the doctors saw was enough to call for three rounds of BEP chemotherapy. There were enlarged lymph nodes and they were bad enough that two doctors felt the cancer had entered his blood stream.
Now that my husband made it through chemo, his doctor ordered a PET scan from the pelvis up to the neck. CIGNA only wants to pay for CT scans of the pelvis and abdomen, plus an x-ray of the chest. This is not enough to conclusively know whether his treatment was successful or not. We asked for a peer to peer and our doctor said he'd never spoken to such *** people. Med Solutions, Cigna's third party reviewers, will most surely decline our appeal, so we will need to fork up approx. $4,000 for the PET scan, as I am not playing games with my husband's health.
If anyone has any suggestions on legal representation, please post this. I cannot believe these idiots would pay over 30k for chemo, but not pay for definitive imaging afterwards... Their excuse - he showed no additional tumors in the initial imaging and his markers are normal (which they were even when he had the cancerous testicle...).
We will never choose this insurance company again and he will soon transfer to my Blue Cross/Blue Shield, which is way better.
Product or Service Mentioned: Cigna Health Insurance.
Monetary Loss: $4200.