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Medicare and PET scans for kidney cancer folks

Dutch1's picture
Dutch1
Posts: 152
Joined: Mar 2014

I'm on medicare, with a supplemental policy to cover what medicare won't.

I've had 3 or 4 PET scans in the past and my doctor wants another one this week because the cancer has decided to move into my right lung.  For a couple of reasons, my doctor wants the PET scan this time (I've had many, many CT scans over my 7-year stint with kidney cancer).

There is confusion as to how well medicare will cover PET scans.  The story which bothers me is that medicare supposedly covers only 3 or 4 PET scans per "cancer episode".  If this is true, I am on my own to cover the cost of this upcoming PET scan.  

Does anyone on the discussion board have experience with this medicare issue?  I need some insight -- and I need it quickly.

If anyone can help, I would be thankful.

 

Dutch

a_oaklee
Posts: 520
Joined: Nov 2013

Hi Dutch.  All I can tell you is that my husband has always had CT/PET scans.  Now he has them annually, but for a long time it was much shorter intervals.  2 month, 3 month, etc..  Have never had a problem with Medicare and the supplement he has.  He also gets MRIs at the same time.  No problems.

Dutch1's picture
Dutch1
Posts: 152
Joined: Mar 2014

Thanks for the information.  This is what I'm looking for.

Dutch

Dutch1's picture
Dutch1
Posts: 152
Joined: Mar 2014

Found more encouraging news -- should anyone else wonder about the Medicare coverage of scans.

My supplemental policy company is saying that they haven't had any trouble from CMS over the number of PET scans one has.  Criteria for allowing is all dependent upon health reasons -- nothing about how many scans one has had.

I mustered up the courage to call CMS.  Same thing.  If the patient needs the PET scan for medical reasons, it's covered.

Dutch

AliceB1950's picture
AliceB1950
Posts: 56
Joined: Jun 2019

Even with my Medicare Advantage plan, the one PET scan I had came with a copay over $900.  We did a same-day payment to get a discount, but it was quite a sticker shock.

a_oaklee
Posts: 520
Joined: Nov 2013

Thanks for the info Dutch.

I assume coverage is based on what supplemental plan you have.

We dont pay any copays.  Targeted therapy prices are crazy high, and we do pay for that.

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