what recourse does a patient have when insurance company refuses to pay for test ordered by a dcotor?

I live in Colorado and have health insurance with BC BS of CA.  I have Testicular Cancer and my oncologist ordered a PET scan which the insurance company is refusing to pay for beause they say it was not necessary.  I have gone through the review process with the insurance company and was denied.  My doctor’s office said they will take care of $3000.00 of the $4000.00 bill and I am responsible for the rest. Do I put in a complaint with the insurance commission? If so, in what State, Colorado? When you have cancer and your Dr orders a test for you why is it the patient’s responsibility to pay when denied?

Asked on June 16, 2009 under Insurance Law, Connecticut


L.M., Member, California Bar / FreeAdvice Contributing Attorney

Answered 11 years ago | Contributor

It shouldn't be your responsibility, but you and your dr.'s office should have gotten a pre-approval from the insurance company before having the test.  PET scans are very expensive, but how are you to know that?  I would make a complaint to your state's dept. of insurance.  I would also let the dr.'s office know that you cannot afford to pay for the test and your insurance won't cover it.  Ask them what their suggestion is.  Sometimes dr.'s offices have a share in the radiology office that does the testing and therefore takes a piece of the profit.  If that's the case here, they can just write off the whole amount. See what they can do for you.

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