Shouldn't have been so surprised; this is a bitch. Our friend Vonda in Indiana has a small spot in her lung, has gotten so far various X-rays, CT scans, and finally a PET scan. Last night I researched PET scan thoroughly; it is the most complex, but most revealing and useful type of scan for tumor diagnosis. Technically complicated because a radioactive liquid is injected into the general bloodstream and the scanning must be done as soon as possible. The radioisotope has a short half-life, usually being Fluorine 18 with half life of 110 minutes. This means that a given sample of Fl-18 after 110 minutes will be one-half as radioactive as at the start, then one-half of what's left will be gone after the second 110 minutes, and so on until after 5 or more half-lives, radioactivity is gone. This is used to limit maximum radiation received by the patient. Shipping Fl-18 to a use-point from manufacturing wastes that valuable time, so often it is produced right at the PET scan machine, in the same room. This requires use of a cyclotron, or "atom-smasher" as they were called, very expensive, large, complex, requiring highly skilled operation. The Fl-18 is produced by bombarding Oxygen 18 atoms in special 0-18 water with high energy protons via the cyclotron. The Fl-18 isotope is a POSITRON EMITTER, a fairly unusual type of radioisotope. I had no idea PET was so complex and delicate. As far as Vonda goes, she has now been offered several choices, even before the actual written diagnosis of CANCER has been made. That's why I'm writing. Originally, PET scans cost upwards of $20,000; today it averages $5,000 in U.S., less in UK, Canada, and Australia, which is immaterial. Most health insurance companies follow this rule: if the PET scan is ordered BEFORE formal diagnosis is made, they will pay for it. If ordered AFTER diagnosis, payment is denied! Can one see any "justice" in this? If Vonda's Oncologist muttered "cancer" a week ago, she and her husband Gary could be hung for payment, even though they have good insurance. The "politics of diagnosis"...........DAMN them. Frank
So, if I’m getting it right, if the doctor had written in a solid diagnosis, the insurance company could grab a loophole in the wording describing a previous condition?
@Bobby Cole Yes. Seems unfair in a life or death struggle, no? Can't wring money out of a dead person. Frank
When the politicians speak of prior conditions, perhaps they need to be made aware of that single loophole and start from there. Dunno. I believe it was Forbes who said that 98% of the wealth of the world is controlled by insurance companies and I think I might be correct with the assumption that the lawyers that represent them are not far behind.
@Frank Sanoica -- sorry about your friend. I think most doctors are aware of the "loopholes" and many of them operate in a way to squeeze the most $$ from insurance companies.
The doctors who learned and know how to test for cancer outside the ama protocols, can do all the testing needed for under a few hundred dollars total, and find out what is causing the 'problem', instead of just finding out that someone might be diagnosed and then treat the symptoms.... treating the deficiency, the toxicity, or whatever is unbalanced, whatever if anything is lacking or broken, i.e. treating the cause of a spot, causes the spot to go away. Without using drugs or toxins or burning .... sometimes surgery helps....