Scans post treatment

annie4145
annie4145 Member Posts: 218 Member
in Anal Cancer #1

Who has been successful in receiving a 6 month post treatment PET/CT scan?  I was rejected by insurance in pre-authorization, and then told that I didn't need authorization. Worried that I will get the scan and then have to pay for it all if insurance rejects the bill.  Does anyone have Blue Cross/Blue Shield for federal employees (my husband's insurance), and did they pay that cost?

 

thanks,

Barbara

Comments

  • eihtak
    eihtak Member Posts: 1,473 Member
    #2
    annie4145...

    Hi,

    While I have not had this issue, my husband (different oncologist than I ) has. Often he needs to request his doctor changes the wording on his request although even that does not always work. It seems it is not uncommon for many insurance companies to deny coverage for surveillance purposes and only cover if your doctor believes your cancer has returned (based on other tests, ex.blood work), to better dx an existing condition, or is medically necessary. Sometimes the CT scan or MRI will be covered first and then if a concern a PET will be covered. 

    My doctor rarely does PET. I had one initially at time of dx (over 8 years ago), then at 1 year follow-up, then regular 6 month CT scans and then a PET to better dx a lung met first found on a CT.

    Good luck with this...the jumping through hoops and red tape part of this journey requires more energy than we should have to put forth!!

    katheryn

  • tanda
    tanda Member Posts: 174 Member
    #3
    annie4145

    Federal Blue Cross works a bit diferently than other insurers...I don't have it so I dont't know any details.

    Depending on your stage, the new NCCN Guidelines do not recommend routine  followup scans.  I had a PET/CT as part of my workup staging; and one or two CT's post-treatment.  My original oncologist moved and the replacement oncologist decided that more scans were not necessary.  Howver,  when I reach the 5 year mark I might ask about a "farewell scan."

     

    Pet scans are very expensive and, especially  soon after treatment, may light up lots of areas that are not significant.  If your dr thinks imaging is important, perhaps a CT scan would be covered.

  • mp327
    mp327 Member Posts: 4,440 Member
    edited April 2019 #4
    annie4145

    I was very fortunate to have very good insurance coverage back in 2008 and a few years following.  My oncologist loved PET/CT scans and I had numerous scans during the first few years after my treatment, probably too many.  However, my insurance coverage changed and the new insurance company put the brakes on further scans.  PET/CT's are very expensive and, unless needed for a new diagnosis or as a follow-up because of evidence of recurrence, insurance companies do not like to appove them.  Is it possible that your insurance company would approve a CT scan?  I would definitely ask your doctor if a CT would be adequate.  It would certainly be better than nothing.

  • Mollymaude
    Mollymaude Member Posts: 431 Member
    #5
    Pet scan

    I had pet scan before treatment but not after because I had no node involvement. I have federal BC/BS. Pet scan was covered by insurance in my case.

  • Mollymaude
    Mollymaude Member Posts: 431 Member
    #6
    CTs

    i have had regular CTs since treatment and those were all covered by my BC/BS policy

  • Salsify
    Salsify Member Posts: 37 Member
    #7
    Post treatment scans

    I had a Blue Cross plan (not federal) in 2015 & 2016; treament ended Dec.14, 2015 and had a PET scan in March 2016, covered. I guess they wanted to see how well treatment was working - 6 months would have been better if they wanted to see if it was all gone, since radiation keeps working for about that long, at least. At three months there was still a little residual activity going on. Since then I've had a couple of CT scans. Everything was "covered" - except for a $2,000 annual deductible.

    What does your doctor say about it?

  • annie4145
    annie4145 Member Posts: 218 Member
    #8
    Salsify said:

    Post treatment scans

    I had a Blue Cross plan (not federal) in 2015 & 2016; treament ended Dec.14, 2015 and had a PET scan in March 2016, covered. I guess they wanted to see how well treatment was working - 6 months would have been better if they wanted to see if it was all gone, since radiation keeps working for about that long, at least. At three months there was still a little residual activity going on. Since then I've had a couple of CT scans. Everything was "covered" - except for a $2,000 annual deductible.

    What does your doctor say about it?

    Originally she said that it

    Originally she said that it was impossible to fight because it wasn't in the NCCN guidelines.  Then she said that she would try to get it covered.  Talked to the insurance company, trying to nail them down is difficult.  They have conceeded that I don't need to get prequalified, but no answer yet, about whether they will or won't cover it.  (I need to talk to them more tomorrow or next week to try to get a firm answer.)

  • annie4145
    annie4145 Member Posts: 218 Member
    #9
    annie4145 said:

    Originally she said that it

    Originally she said that it was impossible to fight because it wasn't in the NCCN guidelines.  Then she said that she would try to get it covered.  Talked to the insurance company, trying to nail them down is difficult.  They have conceeded that I don't need to get prequalified, but no answer yet, about whether they will or won't cover it.  (I need to talk to them more tomorrow or next week to try to get a firm answer.)

    PS She did say that she liked

    PS She did say that she liked getting the scans...

  • Salsify
    Salsify Member Posts: 37 Member
    #10
    I hope they do cover it, it

    I hope they do cover it, it is so good to know for sure treatment works! But if a CT scan would show nothing left, that would give that same relief...

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