Re:Rejection of CA 19-9 As Experimental

[Guest guest]

Hi Deb,

I'm dealing with this issue right now (BCBS). I was told that the reason my CA 19-9 is being denied is because it is officially 'coded' for a cancer diagnosis, NOT for a PSC diagnosis. My hepatologist is writing a letter of medical necessity as to exactly why this test is used for PSC and is absolutely necessary to detect CCA. I'm having to submit that--along with my entire medical history--to the insurance company, and it is being sent to their medical review board.

If this doesn't work, I know a fabulous not-for-profit patient advocacy lawyer who takes care of things like this all the time, with just a few phone calls or letters. She works for free, or for donations to her not-for-profit group. If you can't win this fight with the insurance company, I'll give you her info. She will probably be able to help.

Genevieve

UC 1983, J-Pouch 1999, PSC 12/07

[Guest guest]

Hi Deb,

I'm dealing with this issue right now (BCBS). I was told that the reason my CA 19-9 is being denied is because it is officially 'coded' for a cancer diagnosis, NOT for a PSC diagnosis. My hepatologist is writing a letter of medical necessity as to exactly why this test is used for PSC and is absolutely necessary to detect CCA. I'm having to submit that--along with my entire medical history--to the insurance company, and it is being sent to their medical review board.

If this doesn't work, I know a fabulous not-for-profit patient advocacy lawyer who takes care of things like this all the time, with just a few phone calls or letters. She works for free, or for donations to her not-for-profit group. If you can't win this fight with the insurance company, I'll give you her info. She will probably be able to help.

Genevieve

UC 1983, J-Pouch 1999, PSC 12/07

[Guest guest]

Hi Deb,

I'm dealing with this issue right now (BCBS). I was told that the reason my CA 19-9 is being denied is because it is officially 'coded' for a cancer diagnosis, NOT for a PSC diagnosis. My hepatologist is writing a letter of medical necessity as to exactly why this test is used for PSC and is absolutely necessary to detect CCA. I'm having to submit that--along with my entire medical history--to the insurance company, and it is being sent to their medical review board.

If this doesn't work, I know a fabulous not-for-profit patient advocacy lawyer who takes care of things like this all the time, with just a few phone calls or letters. She works for free, or for donations to her not-for-profit group. If you can't win this fight with the insurance company, I'll give you her info. She will probably be able to help.

Genevieve

UC 1983, J-Pouch 1999, PSC 12/07

[Guest guest]

I haven't had a problem with BC cover the test; however, my Dr. codes

it for the symptoms I am having and not PSC. The last time he ran it

he coded it on the code for elevated liver enzymes. I don't know if

that might be helpful for you all

Dawn

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> I'm dealing with this issue right now (BCBS). I was told that the

reason my CA 19-9 is being denied is because it is officially 'coded'

for a cancer diagnosis, NOT for a PSC diagnosis.