Abdominal CT denied for patient with diarrhea 3x/day for 1 year

[1SmartGirl]

The title says it all. Last year I asked my GP if it would be a good idea to do some testing because I was having diarrhea every time I ate. "Take some lipase and some Immodium," he said, "don't worry about it." A year later, I realize I have been having these symptoms for decades, but at 3 times per day, the frequency is unbearable. I went back to a previous GP who expressed skepticism but tested for parasites - negative. Then I found a new internist who sent me straight to the imaging center for an abdominal CT with contrast on suspicion of EPI, pancreatitis, and worse. There I sat, all gowned up, my arm out to receive the IV, when the front desk person came to say that my insurance had denied the test. Upon my phone call, they explained that I must have severe abdominal pain, fever, a high white count, or an abdominal mass to justify the test. Diarrhea 3 times a day for over a year was not sufficient. Are there other criteria that justify the abdominal CT per National NCD and LCD policies?

 

[fed up]

Paperwork. It is all paperwork. Your physician should be able to get an exception if he has a conversation with the insurance company. Your exam may be denied until some additional test or waiting period has been completed. I am a diabetic and each year I have to get re-certified to receive some drug which will keep me alive. The plan changes and something which had been approved is now on the not available list.
Have your physician find out what step needs to be completed before they will pay for the CT scan