Insurance rejected an imaging study already performed

My son has lymphoma and thankfully is in remission. He had a PET/MR back in March of 2021 and I just received a letter from the insurance stating they consider this experimental and will not cover it. I am going to call the oncology office on Monday and I’m sure they will try to appeal but my concern is the insurance company will continue to deny the claim and I will be on the hook for $33,000. This was done in the outpatient setting as surveillance post chemo so I’m wondering if the oncology office was supposed to get some type of pre-certification prior to doing the study?

submitted by /u/hemoglobetrotter
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My son has lymphoma and thankfully is in remission. He had a PET/MR back in March of 2021 and I just received a letter from the insurance stating they consider this experimental and will not cover it. I am going to call the oncology office on Monday and I’m sure they will try to appeal but my concern is the insurance company will continue to deny the claim and I will be on the hook for $33,000. This was done in the outpatient setting as surveillance post chemo so I’m wondering if the oncology office was supposed to get some type of pre-certification prior to doing the study?
submitted by /u/hemoglobetrotter [link] [comments]Read Morer/HealthInsurance

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