I was diagnosed with stage III Hodgkin’s Lymphoma in the spring of 2007, after surgery and twelve infusions of chemotherapy I entered remission later that year. Being in remission I needed to have follow-ups every three months with my Oncologist for two years after which I would go to six-month follow-ups. For my type of cancer the only test that truly detects if the lymphoma has returned is a PET scan, a type of nuclear medicine and a very costly procedure but it produces the results that can confirm if the cancer has returned or not. Below the fold I will go into further detail my story as it illustrates the games Doctor’s and patients need to play in order to receive authorizations for procedures from insurance companies.
In the spring of 2008 my Oncologist wanted me to have another PET scan, as it had been six months since I finished chemotherapy and he wanted to confirm I was still in remission. My insurance company denied that request and also his subsequent appeal. I had blood work at an appointment, which was clean, however feeling my neck, which was where I had a sausage size tumor prior to surgery and chemotherapy he felt some things that had him concerned. He wanted me to have a PET scan to confirm the cancer had not returned, the insurance company however denied that request because I had no symptoms. My particular instance of Hodgkin’s was asymptomatic, meaning I never displayed any symptoms but the cancer still managed to advance to stage III. The insurance company would not authorize the PET scan but would authorize an X-Ray of the area which would show if there was anything there but would not ascertain what it was.
I had the X-ray, which indicated that there was something at the site; with those results my Oncologist was able to request and receive authorization for the PET scan. After many nights trying to go to sleep wondering if my cancer had returned the PET scans appointment date came. Fortunately the scan revealed that what he felt and what the X-Ray displayed was residual scar tissue left over from the chemotherapy and surgery.
My fiancée, who is a Doctor, was dismayed at the process we had to go through to get the scans I needed. She was concerned as the X-ray was an unnecessary exposure to radiation which having been through what I had I already had a lot of exposure to. My Oncologist and I came to an agreement that we would not get any scans other than PET scans and would only do so if the blood work indicated a need or other symptoms I never had in the first place arose so that the insurance company would authorize. We deemed this necessary, as we did not want exposure to unnecessary radiation to potentially in the future cause another type of cancer, which unfortunately can and does happen.
So the insurance company ultimately ended up paying more than if they would have authorized the PET in the first place because there were two scans instead of one. Also I was exposed to more radiation than I needed, risking further complications down the road. Radiation exposure could lead to a battle with a more serious cancer that could kill me and would also cost them more money in the process. So do you think we need some type of health care reform in this country?
On a happier note I had my two-year follow-up in August and the blood-work and examination revealed nothing out of the ordinary. For me it meant a graduation from three-month follow-ups to six-month follow-ups, something that made me, and probably the insurance company very happy, for different reasons of course.