Hi everyone, my doctor tried getting a pre-authorization with my insurance (Cigna) for a CT scan with and without contrast and it was denied. Has this happened to anyone else? Should I try to get just one with contrast? It sounds like maybe they would cover one….
Thanks for your help!
Getting a CT w/ contrast would be a fine place to start, @jotanger2. It’s silly that insurance denied a CT w/o & w/ contrast because they’re both done at the same appt. - the non-constrast scan first then contrast is added, & you’re rescanned. It’s very efficient.
If the w/ contrast CT is denied, it may be that your doctor needed to put down a different reason for you to get the CT. For years there was no medical or surgical code for ES so people’s scans were denied simply because their insurance had no billing code for it & for no other reason. You could also call your insurance to get an explanation for why the scans were denied.
If all else fails, there are medical care advocates - sometimes through your health insurance - that can help you get what you need.
@jotanger2 I doubt they are denying it due to with and without contrast. They are probably denying it because of something like medical necessity or they want you to have some other test first or try some type of treatment first (like if the Dr. wrote down neck pain they might want you to try PT first). I would contact the doctor’s office and have them file an appeal. They have to do that all the time, it’s not unusual. Good luck.
Great insight, @Chrickychricky. Thank you for sharing that.
Thank you both for your help! My insurance said they would cover one but not both. I read their letter today and it looks like my doctor mentioned it was to confirm Eagle syndrome, and their doctor who reviewed the pre-authorization recommended the one with contrast. The letter from them says the one without contrast is “unnecessary” but they’d cover the one with contrast. At least I’m getting one! 
Good job following up, @jotanger2! I’m glad you’ve been approved for one at least! That’s a giant step in the right direction.
I’m glad you got approved @jotanger2! I also have Cigna and they have been pretty picky about approving scans. Once they denied an MRI because of the location it was requested at (a hospital) but I later got it approved by scheduling it at a medical center they had listed as in their network (even though the hospital was in their network…). So frustrating.
That’s great they’ll cover a CT with contrast, hopefully it’ll show something conclusive! See if you can get a copy of the images 
Interestingly, this more recent pano x-ray shows my jaw closed (versus the space at the jaw in the one I’ve previously posted), and as a result, the right styloid process looks even longer than I thought. Eagerly awaiting the CT scan—I want this thing out of my neck!
Thanks for all your help, everyone.
Yes, pretty long!
@jotanger2 - Yup! That’s a long styloid!
I had my CT scan with contrast today. While I haven’t seen the full results yet or spoken with a doctor about them, the radiologist’s report says I have bilateral ossification of the stylohyoid ligaments. I had them mail me digital copies of the images.
What is my next step? Should I get a referral to a surgeon? I don’t want to live like this and want them out! I’d like someone who specializes in Eagle syndrome to look at the scans, and I don’t feel like the doctors I’ve met with yet are experts or good at offering next steps. Thank you so much—I am beyond grateful for this group.
HOORAY for confirmation of what you suspected, @jotanger2! That’s a big step in the right direction! Yes you should get a referral to a surgeon if your insurance requires that. Most surgeons don’t require a referral so you can self-refer if your insurance company doesn’t require it.
I think you know we don’t have any doctors on our list for your state, however, an ENT skull based surgeon, neurosurgeon or maxillofacial surgeon often operates in the area where the styloids are & sometimes even has to remove one in the course of a cancer surgery, thus if you can find a local skull based cancer surgeon, you may not have to travel for surgery. If you’re willing & able to travel, there are several doctors in MA & NY & we can highly recommend Dr. Cognetti in Philadelphia, PA, & Dr. Hackman (does bilateral surgery) in Chapel Hill, NC.
Thank you so much! It was such a relief to see that my CT scan didn’t just come back “normal” like so many other tests have. I would like to go to Boston for the surgery since it’s the closest location to my home, and my brother lives outside Boston so I could stay with him. I already go there every few months for lateral pterygoid intraoral injections, which I hopefully won’t need after surgery. (I never had any jaw issues before Eagle syndrome.) I’ve read good things about Dr. Annino. I would definitely want external since I have had so many difficulties with swallowing (my worst symptom I would say) and throat pain/hypersensitivity. I also started a new job in October so I don’t want to have to take more than two weeks off (ha, rounds of interviews with Eagle was not fun).
I cannot thank this group enough. I wouldn’t have known to ask for a CT scan (especially since I’d had a normal x-ray of my neck and a cervical spine MRI already; doctors just didn’t know what to look for). I was starting to think I’d just be forced to live this way forever and that sounds like an absolute nightmare.
Dr. Annino has a good reputation & has helped a number of our members in your area. I hope you’re able to get an appt with him soon.
Congrats on getting that job after interviewing w/ substantial ES symptoms! That’s a real victory for you.
Boston sounds a good bet then…some members have needed more than 2 weeks off though, especially if they have to do anything physical or talk lots as that can be difficult for a few weeks after surgery…just something to bear in mind.
Thank you for all your help! I’m planning to call his office on Monday.
That’s a good reminder that I may need more time. Thankfully, I work remotely (with occasional ground travel, which I would postpone until better). However, I do have a lot of meetings, so I would need to talk less and have my video off for a while. It is difficult for me to talk a lot currently because I feel a pulling and tightening sensation at the corners of my jaw and then my larynx feels tired (part of the charming throat symptoms of ES ). When this first started, I lost my voice for a while and I worked with a speech pathologist. Helpful in addressing the muscle tension, but obviously didn’t solve the root issue. My boss is aware I’ll probably need surgery soon—I told her about the CT scan so she wouldn’t be surprised.
Thank you!
That’s good, it sounds like you can be a bit flexible…
I have a consultation with Dr. Annino in April. I feel relieved just knowing that. Thanks, all!
