CA125 cancer tests and routine denial of coverage

Women of Kos, I need your stories.

I am in the midst of a second appeal with my health insurance provider over their refusal to pay for a simple blood test, CA125, the one that detects ovarian cancer.

I need your help to find out if this is happening to many women, and I figured that with the active health reform community that we have, including nyceve and all of us who want to see this kind of nonsense stop, the women of Kos might be a good source of data.

Read on for the history and a chance to give me some hard data to use to fight this company.

Back in February, I had to have a blood test to be sure I didn't have ovarian cancer. With a suspicious growth on one ovary, one that the radiologist said needed immediate followup, my doc prescribed the CA125 test, to check for ovarian cancer markers in my blood. She also got me in to see a surgeon to further evaluate what was happening.

I was lucky, no markers. The surgeon prescribed the same test when I saw her, three weeks later, based on the same ultrasound evidence. Again, lucky, no markers.

My insurance company, Uniform Medical of the State of Washington, denied payment for the first test, saying it was medically unnecessary. On appeal, they said they only approve this test for "women with high risk factors for ovarian cancer." As if having an undetermined complex mass growing on an ovary wasn't high risk.

Then, they paid for the second test when the second doctor ordered it. But not the first, appeal denied. Whimsy?

I was talking to a friend of mine who has had uterine cancer, and she told me that her company ALWAYS denies the CA125. Even though she had stage 3 cancer, and is being checked every 4 months for re-occurrance.

It's my understanding that ovarian cancer is particularly deadly. One of the worst. Horrible. And usually very silent about its symptoms. And I started wondering if women are being routinely denied coverage for this simple test that helps determine if you have it. It's a simple test. It costs about $111. It's not like we are asking for thousands of dollars of coverage. Routinely denying it seems ridiculous to me.

So I'm wondering if any of you have had the same thing happen -- denial of coverage for the CA125 test. I would like to include some statistics in my second appeal, and I am thinking of doing a video for Michael Moore's youtube page as well. It would be nice to know how many of us are having to pay for this critical test out of pocket. I don't know how else to get this data: how many people get turned down on this test? (I'm sure companies don't publish data on the people they turn down on the web.) So I thought that posting a diary might be one way of finding out. Call it "demographic health care denial of coverage studies."

If you want to comment below, I could get a tally and some stories, which I would include (anonymously for all of you of course) in both my second appeal, and the accompanying video I'm planning to post on Michael Moore's page.

Thanks for your help, and please pimp if you can so that as many women can see this as possible. I'm looking for stories and data from as many women as possible. I will be having to have this test again, probably every few months or so until the propensity for growing suspicious masses stops, and I want this company to understand that they WILL be paying for it. And that they had better reconsider that policy so that all women that they cover will be able to have this test done without this kind of nonsensical denial. I've been lucky so far, but what about all the women who aren't?

Thanks for your help.