Ascending Aortic Aneurysm, Insurance is declining tests. Blue Shield

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ZDAD
Regular Member


Date Joined Sep 2013
Total Posts : 21
   Posted 9/16/2013 8:15 PM (GMT -6)   
Has anybody had this problem? I have an Aneurysm of 4.5 cm, Ascending, and have had a gated MRI every year for the past 2 years. It grew a little but not much. This year, the insurance company declined the MRI and stated "echo cardiogram should be sufficient".
I can't imagine what they would do if I needed the operation.
The best thing that could happen to the insurance company is for my Aneurysm to explode.
Id be dead and it wouldn't cost them a cent. If anybody has any advise on how to deal with this please let me know.
Thank you

Cheri07
Regular Member


Date Joined Sep 2013
Total Posts : 196
   Posted 9/17/2013 2:11 AM (GMT -6)   
I would get the echo done, and if it doesn't give your Dr's sufficient results, then I think your insurance would approve the MRI. Something like that happened with my husband, not for the same thing, but he did what they suggested, and ended up having done what he was supposed to have in the beginning.

ZDAD
Regular Member


Date Joined Sep 2013
Total Posts : 21
   Posted 9/26/2013 4:16 AM (GMT -6)   
Office is telling me the test is booking out 6 months!
Im going to find a new cardiologist who takes my life a little more seriously.
Was told by my PCP that if Cardioligist really went to bat for me, I would be having the test sooner
John Ritter, Three's company doctor told him he was fine. Check out his website his sister started sometime.

ZDAD
Regular Member


Date Joined Sep 2013
Total Posts : 21
   Posted 9/27/2013 8:28 PM (GMT -6)   
Just got a call from the Insurance State Appeals Board. They upheld Blue Shields decision to decline the test.
Reason was "aneurysm measuring 4.2 first year and 4.5 the next is considered stable and an MRI is not necessary"!
Doctor had marked the risk as intermediate, not critical. HMO's I understand, but the state insurance commission agrees with this?
They want me dead.
Im told my only other option is to get an attorney and take them to court.
If I had that kind of money I would pay for the test myself!

stkitt
Elite Member


Date Joined Apr 2007
Total Posts : 32602
   Posted 9/29/2013 1:03 PM (GMT -6)   
 
I am sorry to read of your problem with the insurance company. You took the appropriate  next step and sought out  an independent review through your state department of insurance. These reviews -- available in most states -- favor the consumer over the insurance company more than one-third of the time.  Sometimes an insurance company will go ahead and approve the coverage rather than go through the review process.
 
One third of the time is not the best of odds............... shakehead You are right, the next step would be to hire a lawyer and that is not cheap.
 
Thinking of you and hoping you come up with a solution.
 
Kindly,
Kitt
 
 
~~Kitt~~
Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.



"She Stood in the Storm & When the Wind Did Not Blow Her Away, She Adjusted Her Sails."

ZDAD
Regular Member


Date Joined Sep 2013
Total Posts : 21
   Posted 9/29/2013 9:05 PM (GMT -6)   
Thanks Kitt,
Really at a loss at this point. Amazing to me that an insurance company can turn down a test that can decide life or death, just to save a couple bucks. I guess they don't understand terms like aneurysm and aorta.
I really feel bad for all the others out there who are in these situations.
I will not go quietly into the night.

nightingale57
Regular Member


Date Joined Jun 2013
Total Posts : 42
   Posted 9/30/2013 1:58 PM (GMT -6)   
ZDAD,
  I can't believe you didn't win your appeal.  MRI or CT angiogram are definitely the gold standard. So sorry to hear of your struggles. Keep us informed, keep fighting!
 

ZDAD
Regular Member


Date Joined Sep 2013
Total Posts : 21
   Posted 9/30/2013 3:48 PM (GMT -6)   
Its incredible. They only approved and echo which the cardiologist said he could not get an accurate measurement. They based their decision on a doctor I saw two years ago who wrote "Aorta stable to mild expansion, 4.3 to 4.5, risk intermediate".
Its been two years since my last MRI.
I just got off the phone with the State Medical Board.
They said I needed to get an attorney!
They are giving me a heart attack!

nightingale57
Regular Member


Date Joined Jun 2013
Total Posts : 42
   Posted 10/1/2013 5:23 PM (GMT -6)   
Have you asked for a gated CT angiogram? I am told it is just as diagnostic as an MRI, but doctors prefer the MRI because there is no radiation involved. Its true, no one understands the shadow we live under, having something like this growing in our chest. You definitely don't need the stress. My thoughts are with you ZDAD.
 

ZDAD
Regular Member


Date Joined Sep 2013
Total Posts : 21
   Posted 10/1/2013 7:37 PM (GMT -6)   
The state medical board said that MRI is not revealing in Coronary artery disease.
Now Im trying that explain to them that its not the coronary arteries!
Aorta, not arteries feeding the heart with blood.
Also absence of SOB or pain in chest disqualifies me.
Im started to feel both with what they are putting me through!

nightingale57
Regular Member


Date Joined Jun 2013
Total Posts : 42
   Posted 10/2/2013 8:54 PM (GMT -6)   
That's crazy! Aortic aneurysms are silent killers, no symptoms, that's the whole problem!
 

ZDAD
Regular Member


Date Joined Sep 2013
Total Posts : 21
   Posted 10/2/2013 9:35 PM (GMT -6)   
It sure would save the insurance company a lot of money. How is your recovery going?

nightingale57
Regular Member


Date Joined Jun 2013
Total Posts : 42
   Posted 10/4/2013 9:08 PM (GMT -6)   
Very well, thank you. Walking 2 miles a day!
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