Last year, when my oncologist and I first discussed taking a look at my liver with an MRI--since surgery found a 5mm met that didn't show on CT--he told me that insurance companies were becoming increasingly resistant to approving scans, and we'd have to "make a case for it." Long story short, my pre-, during-, and post-chemo CTs were all NED. But Cigna agreed to an MRI, 12/20/18, which revealed a new 5mm met and two enlarged lymph nodes, which led to starting Keytruda immediately.
So in May, he planned to do another MRI to see what was up with those masses. (No scans since 12/20/18) Anthem BC/BS refused, citing their policy that I had to have a CT scan unless I was allergic to the dye or had some other medical problem. And they took their sweet time about it, I might add. Doc tells me that the "peer-to-peer" consultation consists of him waiting on hold for 10-15 minutes, then having the "physician" simply read the policy to him, and repeat after he explains WHY a CT scan is kind of pointless for me.
Upshot is that I am having a triphasic CT on Wednesday, which apparently shows somewhat more in the liver than the regular kind. But of course, if it shows nothing, we will not be certain whether that means the met is actually gone. *Maybe* we can tell if the nodes have shrunk.
On the other hand, it could show progression. But that's another problem.
So if it looks clear, do we then request an MRI? This is nuts. The insurance co authorized something like 24 infusions of Keytruda, at a cost of probably around $240K, but they will make me potentially have 2 scans instead of one and be exposed to more radiation just because in some cases this policy saves a couple thousand dollars. An MRI will show whether the drug they are prepared to pay over $200K for is actually working.
Last week he told me that companies have been balking at use of approved drugs for their approved purpose, not even off-label, and the latest agony is that they are refusing to authorize lab tests. All for cancer patients.