A new low

Ok, I thought the issue with coverage for Tanner's tests were because they were going to be performed in Arkansas. The lady in the insurance department at MIRT told me the reason given to her for the denial was because "peer to peer" is not an option.

I asked her if that meant they wouldn't cover treatment from an Oncologist in another state if that coverage was available from an Oncologist in the "home" state and she said she "didn't know" that she was "assuming" that wasn't what it meant...  I don't know why she couldn't clarify what it meant???

Today, when I got home from work there was a letter from Medicaid saying that they have denied coverage because of several reasons, foremost being "The clinical information submitted does not describe a patient with Stage I "smoldering myeloma (cancer of plasma cells), solitary plasmacytema (tumor made up of plasma cells), or signs/symptoms suggesting progression of disease."

Another reason, "The clinical information submitted does not describe new or worsening signs/symptoms, or failure of laboratory tests to return to normal in this patient with history of myeloma (cancer of plasma cells). We are unable to authorize the above procedure based on nationally accepted imaging guidelines".

What?  What??

Never once when Tanner was first diagnosed did his "laboratory" work indicate cancer.  The first Oncologist we saw in Fort Worth told me that if they were basing his diagnosis on his lab work, they would think he was completely healthy. Without the full body scan, they would have never found the over 100 cancerous lesions throughout the bones in Tanner's body.

Now, Medicaid wants to deny any further tests because Tanner's lab work doesn't indicate the disease is worsening or progressing.

I'm really without words at this time....