Maybe useful info

jtl
jtl Member Posts: 456
in Head and Neck Cancer #1

For those of you on Medicare who have found that additional scans will not be covered there may be a solution.  Medicare recently approved low dose CT lung scans for people on Medicare, under 77 years old and with a history of smoking.  You must have smoked within the last 15 years and smoked on average of one pack per day for 30 years (ie 30 pack years).  Of course there is no way to confirm how much you smoked or for how long.

I availed myself of this benefit.  They scan from the chin to the abdomen so those with cancer in the oropharynx  are covered.  You probably know that if you were to have a metastastis the lungs are very much at risk.  In my case a couple of very small nodules were found, one of which has not changed in 4 years and the other has a less than 1% chance of being a problem.  

Anyway this may be a no cost solution for a scan.

John

 

Comments

  • hwt
    hwt Member Posts: 2,328 Member
    #2
    John

    Thanks for sharing. I am a bit concerned as i get scanned every 3-4 months and turn 65 in January. It never dawned on me that there was a chance Medicare would discontinue my scans.

  • jtl
    jtl Member Posts: 456
    #3
    hwt said:

    John

    Thanks for sharing. I am a bit concerned as i get scanned every 3-4 months and turn 65 in January. It never dawned on me that there was a chance Medicare would discontinue my scans.

    Scans

    Medicare changed the rules a while back.  They will only allow 3 post DX scans.  I believe that includes people who recently enrolled in Medicare but had previous scans under private insurance.  I actually had 4 before they cut me off.

    John

  • phrannie51
    phrannie51 Member Posts: 4,716
    #4
    I'm wondering....

    Does this scan schedule include recurrences?  Also wondering if a person has a supplement, if they pick up where Medicare leaves off?

    p

  • jcortney
    jcortney Member Posts: 503
    #5
    I'm really confused

    I've read these posts about medicare not approving scans and I'm confused because my experience has been directly opposite.  I've had a H&N CT every 8 weeks for the last year.  Never once has there been a hiccup from either medicare or my supplemental insurer United Health Care (AARP).  Don't know why some have issues and some don't.

    Joe

  • jtl
    jtl Member Posts: 456
    #6
    phrannie51 said:

    I'm wondering....

    Does this scan schedule include recurrences?  Also wondering if a person has a supplement, if they pick up where Medicare leaves off?

    p

    Phrannie

    P, the scan I am referring to is for lung cancer screening due to smoking but it will pick up anything abnormal in the lungs.  In your case it sounds like you have a "new" cancer and you start over on the CT/PET limits.  I have a supplement and yes they pay for the Medicare co-pays and the deductible.  I have never had a bill to pay out of pocket for anything that was covered by Medicare.

  • jtl
    jtl Member Posts: 456
    #7
    jcortney said:

    I'm really confused

    I've read these posts about medicare not approving scans and I'm confused because my experience has been directly opposite.  I've had a H&N CT every 8 weeks for the last year.  Never once has there been a hiccup from either medicare or my supplemental insurer United Health Care (AARP).  Don't know why some have issues and some don't.

    Joe

    PET Scans

    It may be that the limitation of 3 scans is only for PET or CT/PET but not regular CT.  The following is from CMS

    CMS has determined that three FDG PET scans are covered under § 1862(a)(1)(A) when used to guide subsequent management of anti-tumor treatment strategy after completion of initial anticancer therapy.  Coverage of any additional FDG PET scans (that is, beyond three) used to guide subsequent management of anti-tumor treatment strategy after completion of initial anti-tumor therapy will be determined by local Medicare Administrative Contractors. 

    I was told by my ENT and by my rad ONC that Medicare will not pay for any more CT/ PET scans.  I had one before treatment and 3 post. If my docs good provide a good reason to get more scans perhaps I could get them covered but since I don't have any issues that isn't going to happen.  At one point I was just going to pay for one since I could get the Medicare price of $1600.

    John

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