• My doctor wants me to have a PET scan but my insurance is saying they won't pay for one now.

    Asked by Coloman on Wednesday, February 19, 2020

    My doctor wants me to have a PET scan but my insurance is saying they won't pay for one now.

    They say a PET is not needed now, wants them to do a ct scan first. This makes no sense to me at all. Why spend the money on a CT then when it won't show what they need they then pay for a PET. This is what's wrong with healthcare in our country these days. Anyone else having trouble getting a PET paid?

    13 Answers from the Community

    13 answers
    • Bengal's Avatar

      Not alot insurance co's do makes sense. Last year I had extreme pain in my right shoulder. I suspected a torn rotator cuff and asked for an MRI to confirm it. Nooooooo. First I had to go through months of at times very painful physical therapy (paid for by my insurance) until finally I had "met the requirements" to be allowed the MRI. And, YES! I had a torn rotator cuff. Could have saved themselves a lot of money if we'd just done that first. The system is broke. Our doctors, with patient input, should be making these decisions not somebody behind a desk at an insurance as company. IMO.

      about 1 month ago
    • Dawsonsmom's Avatar

      These insurance issues are the primary reason I retired from healthcare. I got exhausted with all the insurance hoops I had to jump through and the patients jumped through more or had treatment delayed while I was jumping.

      about 1 month ago
    • po18guy's Avatar

      You may have an insurance problem, but potentially not, hard as that is to believe. Such problems are not insurmountable. Doctor is well aware of arguments used to get the insurance companies to flex and pay for a PET/CT. Doctor is arguing with other licensed doctors who are employed by the insurance company.

      What is doctor's purpose for the scan? Disease activity, whether progression or regression? Then, a CT might just be fine as it indicates masses, which may then be measured. If the aggressiveness of the cancer is at issue, then a PET might be appropriate.

      The crux of the matter is the purpose of the scan. If you are in treatment, or being scanned to determine the effectiveness of that treatment, then doctor has a more persuasive argument.

      about 1 month ago
    • BoiseB's Avatar

      I am having trouble with my insurance. The insurance pays for the scan but does not pay for the radiologist who reads the scan. I am putting off follow up scans which were due in November because I am still dealing with the ones I had in November. It is my opinion that Dr.s have enough on their hands healing their patient without dealing with insurance problems

      about 1 month ago
    • GregP_WN's Avatar

      I wanted a pet when I received my latest diagnosis. My doctor said she didn't think it was necessary but would order it if my insurance would pay for it. That shot that down. My insurance will barely pay for what they say they will pay.

      about 1 month ago
    • Bengal's Avatar

      I mentioned before; one of my doctors stills maintains an independent practice. He told me one day it used to take 3 people to run his office but now it takes 8 people to keep up with all the regulations and insurance paperwork. And we wonder why a single office visit costs so much?

      about 1 month ago
    • PaulineJ's Avatar

      I'm with all these comments.No need to add another comment.
      I guess I'm just tired in being forever in the wrong catagory to get what I need

      about 1 month ago
    • JaneA's Avatar

      Your doctor's staff will probably wrangle with the insurance company should your oncologist really, really need it. PET scans provide answers when you need to know if radiation killed a lung met. But they also give false positives leading to more tests.

      about 1 month ago
    • BuckeyeShelby's Avatar

      There is at least one thing you can try. I work in the industry. Call your carrier and ask them how to file an appeal. Generally, you write a letter explaining why you think it's necessary. It would be helpful to include a letter of medical necessity from your doctor, too, and maybe supporting medical records. Do *NOT* let the customer service rep get nasty with you, as it is no skin off their nose whether your appeal is granted -- I audit customer service phone calls, so I nail my reps if they get mean with their callers. Good luck!

      about 1 month ago
    • PattyF's Avatar

      My doctors at MSKCC said PET scans weren't as reliable so I have only been given CT scans and an MRI with dye. My comment doesn't help with your insurance problem, but may a CT scan would be best to do first. Good luck

      about 1 month ago
    • smlroger's Avatar

      Since June 2018 I have been getting a PET scan every 3-4 months. Each time my doctor warns that insurance may reject the request. Where I go the scan is about $16K so I understand where the insurance company is coming from. But, so far they have never questioned or rejected a request. I give 100% of the credit to my oncologist for being very good at creative writing. Who know the next one in May be rejected. We shall see.

      about 1 month ago
    • Mark-gb's Avatar

      My understanding is this :-
      CAT - Best for scanning solid tissues (Bone, etc) - but can also get a good view of tumours
      MRI - Best for scanning soft tissues (Organs, Tumours, etc)
      PET - Best for seeing where growth is occurring (i.e. in Metastatic disease early signs of spread into new areas)

      about 1 month ago
    • LiveWithCancer's Avatar

      My oncologist personally hates the PET scan. He won't prescribe one even when I have asked for one. He believes there are far too many false positives with PET scans, resulting in unnecessary worry, biopsies, and other tests. I have had one PET scan since my diagnosis in 2012 ... and more CT scans than I can count. We can easily see the tumors in my lungs and determine any growth by comparing the various CT scans.

      about 1 month ago

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