Insurance Companies and Coverage for Low Dosage CAT Scans

September 3, 2008 - May 28, 2011.  It's hard to believe it now, but as I look back at emails from the period, I spent one year and seven months trying to get my insurance to cover the cost of a low dosage CAT scan.  After our September 3, 2008 visit with Dr. Lewin in which she indicated that Ben would need a CAT scan to see whether he as a candidate for canalplasty, I started to do a little research.

As mentioned in the "Associated Topics" blog, I had been asked by so many specialists over the years to get a CAT scan of Ben - and I'm so glad that I followed the advice of my pediatrican who said, "Don't do it yet!"  The amount of radiation that a child is exposed to from a CAT scan is thousands of times more than an x-ray and it is at levels intended for an adult.  In addition, the reason why radiation is considered dangerous and a potential carcinogen is because of the possiblity that radiation can cause cell mutations.  If the cell mutation happens in a 60 year old, there is much less time (between 60 and the end of the 60 year old's life) for the cells to become cancerous.  In a child, there is an entire lifetime during which the cells can grow and become cancerous.  Furthermore, a child goes through much more dramatic growth than an adult.  Therefore, there are lots of reasons why it's a good idea to be circumspect about the amount of radiation to expose your child to.  Yet most CAT scan machines are built with only adult proportions in mind.  Since the machines are incredibly expensive and need to pay for themselves and then generate revenue for the hospitals, it's not "worth it" for hospitals to invest in additional low-dosage machines.  For microtic children, knowing that surgery was not an option until, at the earliest, three years old, why expose a baby or toddler to the radiation?

When I called the California Ear Institute (CEI) to inquire about the annual conference, Sheri Bryne (who is a wonderful resource for microtia but who no longer works at the CEI :(  infomred me that Dr. Joseph Roberson's office had a special low dose radiation CAT scan machine made by Xoran that generates more accurate CAT scans with 1/10 the level of radiation.  We proceeded to get a hand-written note from Dr. Lewin and my pediatrician, Dr. Keene to my insurance company, about the need for the low dosage CAT scan (of which there are none at all of the radiation labs in all of the hospitals associated with Cedars Sinai in Los Angeles)!  The claim was denied and the only CAT scans that they would refer Ben to were those at Cedar Sinai Hospital with "regular" CAT scan machines at regular adult levels of radiation.  I have copies of all of these notes and email exchanges between the different parties - it ain't pretty.  We sent articles, research, went through an appeals process - everything.  No dice!  After trying for over a year, I finally decided that time was ticking and I would pick up the tab myself.  Interestingly, Cedar Sinai is also one of the hospitals in the US that was caught over-radiating patients.  Here are two good articles on this topic, one overview and one more specific that includes reference to Cedar Sinai.

Anyway, even though insurance would not pay for it, after a year and a half +, I ended up just calling Dr. Roberson's office in Palo Alto.  They happened to have a cancellation the following day, and I cancelled my appointments the following day and high-tailed it to their Palo Alto offices for a Xoran CAT scan.