CT/PET why insurance pays one over the other?

MelanieT

Hi All,
So the mass like thickening in chris abdoman is getting larger so his Dr wants a PET on the 23rd but insurance will only pay for the CT this time.. Why is that and will the CT show what they need to see?

Loves,
Mel

chicoturner

Hi Mel, I don't know if the
Hi Mel, I don't know if the PET is better then the CT, but I understand that whatever you have started with is what they want you to continue with. I know part of it has to do with consistency of reading the scans. Comparing apples to apples idea. If there is a reason your Dr. now wants a PET he/she will have to sell it to the insurance co. Best to you. Jean

HeartofSoul

chicoturner said:

Hi Mel, I don't know if the
Hi Mel, I don't know if the PET is better then the CT, but I understand that whatever you have started with is what they want you to continue with. I know part of it has to do with consistency of reading the scans. Comparing apples to apples idea. If there is a reason your Dr. now wants a PET he/she will have to sell it to the insurance co. Best to you. Jean

$$$$$$$$$$$$$$$$$$$$$$ ,
$$$$$$$$$$$$$$$$$$$$$$ , prices vary by region but Pets usually twice that of Cats and yes if you had a cat before and now a pet, the comparison not as clean as cat to cat. whats scary about not getting a pet is unless they do a full body cat scan, cats can focus on sections of the body and miss other regions in an attempt to locate any detectable tumors, which a Pet can do. Pets can have false positive readings though.

lisa42

dr. can appeal the ins. decision
A CT scan will show if the thickening has lessened, stayed the same, or has grown in size. It obviously won't show any cancerous activity or not like the PET would. I now have Health Net, but when I had Aetna, they would limit how often I could get a PET/CT done vs. just a regular CT. So my then-onc would alternate CT one time, a PET/CT the next time. That really didn't make much sense, though, because it was like comparing apples to oranges from one scan to the next.

There was one time when my onc wanted a scan done earlier than the required minimum of 12 weeks from one scan to the next that the insurance required. They denied it at first, but the doctor resubmitted his request with written documentation of why it was medically needed to have the scan earlier. The insurance gave in and approved it.
I'm thinking if your doctor submits the request again to your insurance with written reason of why he needs a PET scan this time, they'd probably go along with it.
Another reason the insurance may balk at the PET is that I believe PET scans are more expensive than CT scans.

Good luck-

Lisa

MelanieT

lisa42 said:

dr. can appeal the ins. decision
A CT scan will show if the thickening has lessened, stayed the same, or has grown in size. It obviously won't show any cancerous activity or not like the PET would. I now have Health Net, but when I had Aetna, they would limit how often I could get a PET/CT done vs. just a regular CT. So my then-onc would alternate CT one time, a PET/CT the next time. That really didn't make much sense, though, because it was like comparing apples to oranges from one scan to the next.

There was one time when my onc wanted a scan done earlier than the required minimum of 12 weeks from one scan to the next that the insurance required. They denied it at first, but the doctor resubmitted his request with written documentation of why it was medically needed to have the scan earlier. The insurance gave in and approved it.
I'm thinking if your doctor submits the request again to your insurance with written reason of why he needs a PET scan this time, they'd probably go along with it.
Another reason the insurance may balk at the PET is that I believe PET scans are more expensive than CT scans.

Good luck-

Lisa

thanks everyone.... i
thanks everyone.... i figured it was a money thing but i guess i just didnt understand that if we are looking to rule out cancer then why just the CT. Chris has not had a scan since June so i am confused of why they are being weird about it.. He said we can do the PET in Dec but if this is cancer that is a long time to just do nothing... I am going to call today and see if i can get them to resubmit it.. thanks so much

Loves,
Mel

LOUSWIFT

cost
I had a ct/Pet scan in May. Insurance didn't like it but it comes down to cost. PET scan is far more expensive for insurance. The one in May 2010 cost $7300 dollars while the one prior December 2007 was $4000. We have four large hospitals where I live. In 2007 there was one Pet scan machine for all of the hospitals to use. Now each hosital has at least one and the pet scans run all the time ( might be a real need might be some profit involved). Now are they reliable? The answer is yes-most of the time. I had a small slow growing tumor when the they did the pet scan and Ct scan in May. They found nothing "ALL CLEAR" but four months later in a colonoscopy performed in August surprise surprise there was cancer. The doctors said how about that and suggested that because my tumor was growing so slow it likely didn't absorb the radioactive glucose at a rate they could be clearly seen...what? Anyway if there is cancer and it is not in the colon a Pet scan is much better than a Ct scan I have been told.

John23

Pet or CT
Pet scans use radioactive glucose with the concept that cancer
cells use more glucose than normal cells, and will "light up"
with the scan.

Nice concept, but most surgeons prefer the CT for accuracy.
And.... the radiation with a PET is nothing to dismiss too quickly;
is it really a good thing?

A PET won't isolate a cancer that isn't taking in more glucose
than a normal cell area, and of course, chemotherapy drugs also
won't work as well in such a condition.

If the surgeon or oncologist is happy with a CT, I wouldn't doubt
their judgement.

If in serious doubt, get another opinion; you are entitled to no
less than that.

Good health!

John