LymeNet Flash: Spect scan studies... insurance denial

This is topic Spect scan studies... insurance denial in forum Medical Questions at LymeNet Flash.

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Posted by Brent (Member # 12797) on :

My insurance company, Blue Cross of Philadelphia, denied a Spect scan ordered by my neurologist,Dr.R in NJ.

My MRI showed " a small linear T2/Flair hyperintensity in the left peritrigonal white matter is seen which does not enhance and is nonspecific"

Dr. R is appealing this ruling.

Can anyone point me to any studies to help me in getting this spect scan approved?

Thank You,

[ 09. March 2008, 10:43 PM: Message edited by: Brent ]

Posted by tailz (Member # 10014) on :

I had a SPECT scan, and I don't think it's 'proof' of Lyme anyway, so why radiate your head just to satisfy your curiosity?

I regret having mine. I'm electrosensitive, and as soon as she hit the 'on' button, I spent the next 45 minutes trying not to pee myself - no lie.

Of course, I can't really tell any doctor this because they will tell me that this is impossible. Yep.

Posted by timaca (Member # 6911) on :

Check your insurance policy (which means read it). If spect scans are not specifically mentioned as being not covered...then they should be covered.

Your insurance company is not allowed to dictate your medical care...unless something is specifically stated as so in your policy.

Timaca

Posted by Brent (Member # 12797) on :

Thanks for your replies.

tailz.. You are correct that the Spect is not for diagnosing Lyme disease.
I already know I have Lyme. I've been on high dose abx for 8 months.

My symptoms are mostly neurological. My doc thinks I might have Neuroborreliosis.

timaca..I will read my policy. I didn't think of that. Thanks

Posted by adamm (Member # 11910) on :

Hmmm...

doesn't sound like you're seeing what we refer to as

a Lyme-Literate MD, or LLMD. Lyme is a clinical diagnosis, and

it virtually always causes CNS problems. You should

post in seeking a doctor and try to find a practitioner who belongs

to ILADS, the International Lyme and Associated Diseases

Society. One of them wouldn't require a brain scan to

determine whether or not to give you a certain treatment.

I do hope you get things worked out with your insurance,

though.