A family member is experiencing new symptoms that were the precursor to discovering their cancer originally. Unfortunately at diagnosis, they were already stage 4.
The oncologist ordered a specific scan, the insurance company denied it, and then required a "peer to peer" meeting with the doctor. They forced the doctor's hand to accept a different type of scan, which at an earlier point of treatment had returned a false negative for us. And the process is also causing, and has caused in the past, delays to treatment in an extremely time sensitive situation.
What can I possibly do about this peer to peer theater? There is absolutely no way the insurance companies' "peer" knows the latest details about the ever evolving treatment the oncologist is using. And this "peer" certainly knows nothing about my family member's specifics when it comes to their treatment history.
How is this stuff even legal? I googled around and found this disturbingly similar situation blogged by a Dr. Rick Boulay in 2017: https://www.kevinmd.com/blog/2017/09/dear-insurance-doctor-not-peer.html
Then I stumbled upon an old New York Times article that quoted him, about how doctors are sometimes lying to insurance agencies in order to get the treatment their patients desperately need: https://www.nytimes.com/2018/06/21/well/the-strategic-lies-of-oncologists.html (archive: https://archive.md/5lfkU#selection-505.42-505.45)
What the hell is going on? This is absolute madness.
Your doctor rolled. I tell my clients all the time that doctors can’t fight insurance companies for every patient every time. They pick and choose, whether it’s the orthopedic in a work comp carpal tunnel case, or an oncologist wanting to try some new immunotherapy.
You should take this as a signal that your not your doctor’s priority.
My advice would be to go get a second opinion and see if another oncologist feels strongly that the scan is warranted.
I don't have any suggestions for you. The only people happy with their insurance are those who have never tried to use it.
This is the reason poor, colored, foreign people complain about privilege. Your life is worth as much as you can afford, everything else is a lie.
If you can afford traveling to a third world country to be tested, because the prices are lower, do so.