When your doctor is attempting to diagnose your illness or condition, he or she may order a CT scan. A CT (computerized tomography) scan is a diagnostic imaging tool that uses X-ray technology to show detailed images of any part of the body—bones, blood vessels, organs, and muscles. Prior to a surgical procedure, a CT scan can be used for a tissue or fluid biopsy and may be done with or without a contrast agent, depending on the area, to improve the ability of the radiologist to see abnormalities. A CT scan denied by your insurance company can leave you feeling frustrated, frightened, and overwhelmed.
You may be sick, unsure of what’s wrong, and the CT scan could be the tool that makes a definitive diagnosis possible. If you find yourself in such an untenable situation, it’s time to speak to a fierce legal advocate. That advocate is attorney Scott Glovsky and the Law Offices of Scott Glovsky. We will fight for the medical tests, treatments, drugs, or procedures you need, helping you get your health and future back on track.
Why Might a CT Scan Be Denied by Insurance?
A CT scan can be denied by your insurance company for a variety of reasons. The simplest reason is that you may have filled out a form wrong or left off the necessary information. Your doctor’s office could have miscoded the procedure or failed to provide certain information. These are issues that can be easily corrected. In some instances, a CT scan might be an excluded procedure under your health insurance policy, or you may have neglected to obtain the required pre-authorization. Other reasons a CT scan could be denied would be if your insurance company deemed the CT scan to be medically unnecessary.
Since CT scans have been around for a considerable amount of time, an insurer would not likely deem them “experimental” or “investigational.” If your insurer is saying the CT scan is not medically necessary, you may need a letter from your doctor that details why it is necessary. If the letter doesn’t convince the insurance company to approve your CT scan, your attorney can provide guidance to help you file an internal appeal. If the internal appeal is not successful, an external appeal can be filed.
Specific Types of CT Scans That Might Be Denied
Generally speaking, a CT scan will either be done using contrast media or without contrast media. Contrast media improves the ability of a radiologist to find any abnormalities. Some patients are not good candidates for iodine-based contrast media, particularly those with compromised kidney function. The most common type of CT scan with contrast is the double-contrast scan which requires the patient to drink a contrast media prior to the test, in addition to the IV contrast. Improving contrast usually improves the images, allowing a more definitive diagnosis.
What Should You Do if Your CT Scan is Denied by Your Insurance?
If your CT scan is denied by insurance, you do have options. It is extremely important that you keep all correspondence—physical letters as well as emails—from the insurance company. Every time you have a telephone conversation with your insurance company write down the name of the person you spoke with, along with notes regarding what you discussed, and any outcome of that discussion. Have your doctor look at your denial letter and write a letter in response that details all the reasons he or she is prescribing a CT scan.
If none of these tactics are successful, your attorney can guide you to file an internal appeal. This appeal is with your insurance company, but different people will look at your claim than those that initially denied the claim. If your internal appeal is unsuccessful, an external appeal with a third party can be filed. The decision of this third party is binding upon the insurance company. We recommend you speak with a health insurance denial attorney before filing an external appeal since he or she may recommend taking a different route instead. Attorney Scott Glovsky has extensive experience with both internal and external appeals. We understand the time constraints involved and will work hard to get you the treatment you need.
What Insurance Companies Are More Likely to Deny A CT Scan?
Although any insurance company could potentially deny a CT Scan, some may be more likely to do so than others. Cigna has recently come under fire for denying necessary medical tests. Over a period of two months in 2022, Cigna doctors denied more than 300,000 requests for payments after spending an average of 1.2 seconds on each case. California insurance companies that may have denied your claim include:
Are There Alternatives to CT Scans?
If your insurance company denies payment for a CT scan, is there an alternative test that can help your doctor diagnose your medical issue? Unfortunately, a CT scan is somewhere in between an X-ray and an MRI as far as giving a clear reading and for cost as well. Doctors rarely ask for a CT scan unless they believe it is necessary to allow them to diagnose a medical issue, and the same is true for an MRI. If your insurance company refuses to pay for a CT scan, they are unlikely to pay for an MRI either. Rather than looking for an alternative, the better choice is for attorney Scott Glovsky to force your insurance company to hold up their end of the bargain and pay for this necessary test.
What is the Time Frame for an Internal Appeal?
Unless an expedited appeal is requested, internal appeals generally follow the following timeline—although every insurance company may have different processes for an internal appeal. Once your health insurance company denies your CT Scan, you must complete all the necessary appeal forms within 180 days of the original denial. The insurer must make a decision on the appeal within 30 days for prior authorization, within 60 days for medical services already received, or within 72 hours for urgent care cases.
How the Law Offices of Scott Glovsky Can Help When Your CT Scan is Denied by Insurance
Attorney Scott Glovsky has experience working on the “other side,” for large corporate law firms that defend insurance companies. This allows Scott to have a thorough understanding of how insurance companies think and the tactics they use to deny claim payments. The Law Offices of Scott Glovsky is highly client-centric. We take fewer cases, which ensures we can devote the time necessary to each and every client. Scott really gets to know his clients, their health issues, their families, and their dreams for the future. He is 100 percent invested in a positive outcome for you—and for every client. The Law Offices of Scott Glovsky has a highly successful, very impressive track record of positive outcomes, while simultaneously providing the highest level of personal care and support. Contact the Law Offices of Scott Glovsky today.