• PET Scan for Leiomyosarcoma in uterus and vagina

    Asked by Braids on Thursday, July 11, 2013

    PET Scan for Leiomyosarcoma in uterus and vagina

    Aetna denied coverage for the scan. Paying for it myself but wonder why refusal? Is PET not any better than CT scan for sarcomas. Had hysterectomy in January and removal of vaginal tumor in June. Scan needed to plan radiation treatment. Doctors even had peer-to-peer but they said they do not cover PET for any sarcomas.

    5 Answers from the Community

    5 answers
    • BuckeyeShelby's Avatar

      I work in the insurance industry. My suggestion -- call your insurance carrier and ask for the procedure to file an appeal. Generally, you need to put it in writing and include a letter of medical necessity from your doctor and possibly med records to back your request. More than likely it is a cost issue. Cost vs effectiveness of the test. And I'm not a doctor, so I have no clue how effective a PET is for your particular situation. You may want to discuss w/your doc whether a CT would be as effective as a PET. I know my doctor is sticking w/CT because that's what we started with, and he wants to compare apples to apples going forward. Good luck. And don't let the phone reps @ your insurance carrier be nasty to you -- ask for a supervisor if they start. They have no vested interest in whether your appeal is approved or not.

      almost 8 years ago
    • GregP_WN's Avatar

      @BuckeyeShelby has a good suggestion. Call the insurance company and be firm, don't take the fact that they said not covered to be the final statement on it. I too was in the insurance business years ago, I know that most companies have people that their sole job is to look at the cases and see if they have to pay or not, and deny if they can. Sad, but true. I had my Doctor send a letter to my insurance company to get a deductible waived. The ins. company kept saying that everything I was having done was a new event, but it was all for the cancer, same event. They covered it finally.
      Here is our Guide to Cancer on talking to your insurance company, take a look and see if anything there helps you, https://www.whatnext.com/cc/talking_to_your_insurance_company

      almost 8 years ago
    • GypsyJule's Avatar

      I agree completely with Shelby and Greg. File an appeal with the insurance company. My dx was Uterine Carcinosarcoma - a combination of a carcinoma and a sarcoma. I have had a PET scan that was paid by my insurance, United Healthcare. Since treatment, I've only had CT scans, but there didn't appear to be a problem with the PET. You may even want to check with the hospital/doctors office to help you with the appeal. My insurance originally denied a hospital stay while I was in treatment and had a 102 degree fever. The oncology department wrote the appeal, and it was paid. (They want the insurance money, so they may help you get it!) Good luck!

      almost 8 years ago
    • Deidre's Avatar

      I agree also, file an appeal with insurance. I have done that successfully before. I just had a PET scan and my insurance was billed thousands of dollars, so it is expensive. But one of my doctors said he didn't think a PET was any better than a CT scan anyway.

      almost 8 years ago
    • Joachima's Avatar

      My uterine cancer was also a sarcoma and I have Aetna insurance. My gyn oncologist wanted a PET Scan following a suspicious area found on a CAT Scan. Aetna refused, and my doctor appealed & persisted through phone calls until finally it was approved, also to plan radiation treatment. I was told that PET Scans are not an approved source of detecting sarcoma. I was further told that Aetna would consider paying only as follow up after the CAT Scan showed something suspicious, as it was in my case.

      almost 8 years ago

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