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Pet/Ct scans

Tonora
Posts: 8
Joined: Oct 2011

The stage of my anal cancer was T2 without any lymph node involvement or mets. NCCN guidelines does not indicate a Pet or Ct scan for anal cancer in remission. I am not sure my insurance company will pay for a PET/CT scan in view of the NCCN guidelines, so I am not sure I should go ahead and have one. What has been your experiences with insurance companies with regard to this issue?

z's picture
z
Posts: 1249
Joined: May 2009

My insurance has paid for what ever the oncologist orders. Its the way the dr explains why its needed. My oncologists explains that its required to rule out metastasis. Usually the insurance will deny then will approve, I don't know why they do it that way, maybe they hope you will not try again. I was Stage IINOMO also.

duckyann
Posts: 162
Joined: Jun 2009

I was also stage 2. My insurance covered my first 2 PET/CT's but the doctor had to get authorization from the insurance. I just had a CT scan on Friday because they would not cover the PET/CT this time. As Lori said a lot of times it depends on how your doctor explains it. Unfortunately this time for me it didn't matter. You can have the doctor get it authorized first so that you do not get stuck paying for it.

mp327's picture
mp327
Posts: 2889
Joined: Jan 2010

I am 3 years post-treatment and had probably 7 or 8 post-treatment PET scans. My doc wanted me to get another one this past August, however, my ins. did not approve it, so I had a CT scan instead. My doctor did have to appeal their non-authorization on previously ordered scans, and they authorized them. However, this last time they gave a definite "no."

AZANNIE
Posts: 382
Joined: Mar 2011

Gee, I better check to see if my insurance will pay for the third PET scan...

mp327's picture
mp327
Posts: 2889
Joined: Jan 2010

The way it's always worked with my ins. is my doctor sends the order to the hospital, then the hospital contacts my ins. co. to get approval for the scan. If they get the okay, then they call me to schedule. If not, they contact my doctor and find out what he wants to do, such as file an appeal or order a different type of scan. My ins. does not require prior authorization for CT or MRI scans.

AZANNIE
Posts: 382
Joined: Mar 2011

Thanks for the info. That's probably the way my insurance works. The onc office contacted the PET scan facility and the facility contacted me to schedule an appointment. That's the way it has worked in the past. Just don't want an expensive surprise.

mp327's picture
mp327
Posts: 2889
Joined: Jan 2010

I would recommend that once you get the appt. scheduled, you contact your ins. co. and just verify that they have approved it. Sometimes my ins. co. would send me a letter of approval and other times not, so I always called to make sure there were no snafus. Better to be safe than sorry!

mxperry220
Posts: 360
Joined: Mar 2011

I was diagnosed with anal cancer in 2008. Aetna is my insurnce company. They paid for Pet Scans in 2008 and 2009. They denied coverage in 2010. I paid for one Pet scan out of pocket in 2010 because the radiologist thought I needed it. I was Stage 2 the same as you. I think the insurance companies have tightened up on these tests due to the fact they are so expensive. My colo rectal surgeon performed a colonoscopy in 2009 and 2011 as well as DRE and scope exams. I m on a 6 month exam schedule.

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