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Pet Scan Denied by Ins

flbchbm's picture
flbchbm
Posts: 3
Joined: Feb 2010

How hard should I fight my insurance company to get a pet scan? I have Tri-Care (military retiree) I had one in early '08 but it has been denied two years in a row now. My oncologist has decided that since he can't get the level of care out of my insurance provider then he's not going to be able to follow me anymore. I had cancer in '94 and it just came back in April of '08. The insurance company says my kind of cancer doesn't warrent a pet scan.

larrycimino
Posts: 9
Joined: Feb 2010

Did the CT show shadows in other parts, outside the anal tumor? if not, I can understand why the PET might be denied. If there were shadows, I'd fight for the PET hard.

flbchbm's picture
flbchbm
Posts: 3
Joined: Feb 2010

A shadow did show up on a regular CT scan and the Doc recommended a guided CT biopsy. But when the PET was denied again he quit on me before I got the guided CT. Now I need to find another Oncologist. He was a GYN Oncologist. My primary care phys was looking for another but there are none in the area so we're looking for one that isn't a GYN type. I don't know what type that will wind up being. Proctology/Oncology?
The GYN Oncologist did do an appeal for me a year after my surgery but it was denied anyway.

mp327's picture
mp327
Posts: 2875
Joined: Jan 2010

I'm sorry to hear that your ins. co. is denying you once again for a PET. You didn't say what type of cancer you had. Has your oncologist written a letter on your behalf to the ins. co. to appeal their decision? If not, you should insist that he do this. If he's not willing, then you should probably find a new oncologist anyway. This is what aggravates me--who better to know what type of follow-ups you need than your doctor--not some person in a cubicle at an ins. co. If the PET scan continues to be denied, then your oncologist has the option of ordering another type of scan for you, CT or MRI. I don't know if these are appropriate for your type of cancer, but if it's anal cancer, many people have these scans for follow-ups instead of PET. Please keep asking questions and don't go without getting some type of follow-up, even if you can't get the PET. I wish you the best.

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