3 pet scans in your life

I am wondering where the life time limitation come into play, as I have found nothing under Medicare itself that says that.

You say you have Humana Medicare - is that an Advantage Plan - and not Medicare Part A and B?

Is it Medicaid that has the limitation?

I know that those on regular insurance plans sometimes have difficulty getting PET scans without the doctor pushing the issue, but even there have not heard any talk about a life time limitation.

Marie who loves kitties

harleywiz said:

pet scans

i looked this up on line it seems there was a study that said that the befit to cancer patients is just as good with cat scan at a lower cost so medicare will pay for only 3 post  pet scans in your life time

Apparently between 2006 and 2013, Medicare only paid for an initial diagnostic PET scan.

In 2013 is was upped to 3.

That being said, there is still room in the "findings" for more to be done if the physician wishes to fight the system.

The wording in the articles is a bit strange, as it never says "in a life time", but I can see how one would get that meaning.

Marie who loves kitties

A full power CT with triple contrast is usually considered better than a PET with anatomical CT at less power and no contrast. However, some here, have had to have the PET to image "shy" mets at all, and it is also possible to get a PET with triple contrast CT at full power, just not as common before lately - we paid extra.  A PET is more likely to have false positives and that costs more money, utilization and worry too.

No doubt part of this problem is the over priced US cost structure $xxxx, some number under $10,000, so they justify "rationing" to avoid "overutilization".  Fact is, there are places overseas where you can get multiple PC-CTs cheaper, like for under $600 average every 3 months on a modern PET-CT 64 slice GE scanner.  

We've had one PET-CT and one "PET-3CT" done so far in 4.6 years.  An MRI and the PET-3CT still didn't image what we are lookng for, yet... Ultmately, I'm hoping for new molecular contrasts to improve CT more.

I have obviously had a pet scan for my cancer.  But last year i had a pet scan required by my coccidiioidomycosis(should I make you look it up, or let you know it is also known as valley fever).   Any way,I suppose that doen't count since it was due to something else.  I have medicare and a supplement paying all my medical bills.  Just my supplement premium of $300 per month.  Between them they have paid over $600,000.00.  Good luck to you all with your medical bills and fights with insurance companies!!!

but my private insurance is very resistant to approving PET scans.  I had to threaten to sue them at one point in order to get one, and that was after the CT scan had twice failed to pick up significant growth.

It's fortunate that under Obamacare one can get unlimited CT scans at least.  Those can also be limited by private insurance.

Betsydoglover said:

Medicare and PET scans

Medicare used to require review/proof of need for PET scans before they would approve and pay.

Now they allow 3 before they revert to their former policy of needing review (and perhaps rarely approving?).  I suspect they would approve for a new cancer or a new met in a different part of the body, but of course I have no idea.

Most private insurance companies are getting very unhappy with pet scans too.

The new Medicare policy is probably an improvement over the previous one in that you can have 3 without  worry about aproval.

 

This has nothing to do with OBAMACARE - Medicare is always changing its coverage policies.

 

Take care,

Betsy

Stage IV

I read your profile, and how wonderful to be a survivor for so many years. Your story fills me with hope. 

Sue - Trubrit

The one that's works in the insurance dept said it was the dual complete not medicare I have part a & b but changed to a dual