HER2 Support Group Forums - View Single Post - Help....Ins denial for annual DEXA payments

harrie · 11-04-2008, 01:05 PM

Rebecca, this is what they wrote:
" According to HMSA's medical policy for Bone (Mineral) Density Studies, follow-up studies performed more frequently than once every two years is limited to individuals on glucocorticoid (steroid) therapy equivalent to 5.0 mg or more or prednisone per day for more than three months, with precertificaton. In addition, bone density studies performed less than 24 months do not adequately reflect bone turnover, do not improve health outcomes, or decrease the incidence of fractures."

A friend of mine (same ins) is also on Femara and has annual DEXAs taken and the insurance covers. She also has osteopenia.

Maryanne

11-04-2008, 01:05 PM	#6
harrie Senior Member Join Date: Mar 2007 Location: Hilo, Hawaii Posts: 1,867	Quote from denial letter Rebecca, this is what they wrote: " According to HMSA's medical policy for Bone (Mineral) Density Studies, follow-up studies performed more frequently than once every two years is limited to individuals on glucocorticoid (steroid) therapy equivalent to 5.0 mg or more or prednisone per day for more than three months, with precertificaton. In addition, bone density studies performed less than 24 months do not adequately reflect bone turnover, do not improve health outcomes, or decrease the incidence of fractures." A friend of mine (same ins) is also on Femara and has annual DEXAs taken and the insurance covers. She also has osteopenia. Maryanne __________________ * MARYANNE * aka HARRIECANARIE 1993: right side DCIS, lumpectomy, rads 1999: left side DCIS, lumpectomy, rads, tamoxifen 2006: BRCA 2 positive Stage I, invasive DCIS (6mm x 5mm) Grade: intermediate sentinal node biopsy: neg HER2/neu amplified 4.7 ER+/PR+ TOPO II neg Oncotype dx 20 Bilat mastectomy with DIEP flap reconstruction oophorectomy 2007: 6 cycles TCH (taxotere, carboplatin, herceptin) finished 1 yr herceptin 05/07 Arimidex, stopped after almost 1 yr Femara