No Pet Scan

usakat said:

Hello Carletta
First, CONGRATULATIONS on finishing chemo! That is a huge milestone in your fight...good for you!

Not to start up a debate here, but insurance companies do not routinely approve or decline one test versus another simply because of cost. Cost is but a part of the determination of whether or not a certain test, procedure or treatment is approved.

As for PET versus CT, everyone who distinguished the difference between PET and CT above is correct. CT provides greater imaging and radiologists are therefore able to see smaller structures. If something abnormal or questionable is seen, certainly for cancer patients, further testing is usually recommended in the CT report issued by the radiologist - typical further testing is PET, MRI, Ultrasound, etc. If further testing is indicated based on CT results, insurance companies would routinely approve the test, unless it's expressly excluded in the policy. As a matter of course, PET scans are more routinely used for Stage IV patients with distant and multiple metastasis and is often indicated to gauge the effectiveness of continual and/or various treatment protocols.

If I had to guess, Carletta, your doctor probably ordered a CT/PET scan - the combo package where you get a CT first and then a PET second. This is ordered for many post-treatment patients. However, a PET scan may not necessarily benefit a patient for two reasons - subjecting the patient to testing and medications (remember PET is nuclear medicine - the FDG-glucose solution injected into patients is radioactive) may not be prudent if the radiologist is not looking for a specific abnormality, and secondly potentially unnecessarily utilizing hospital services thereby subjecting patients and their insurance companies with undue cost. The undue cost situation is one of the hotly debated issues before Congress right now and is an argument that President Obama and others have been making to help control healthcare costs. In my opinion, it's a good issue to discuss.

Carletta, I wouldn't say your insurance is good or bad simply because your insurance company refused this particular test - there are far too many factors to determine whether you have a good policy or bad policy. Something you can do is call your insurance company and ask exactly why the PET was turned down - they will most likely tell you a PET scan is not indicated for your particular case or it could be simply because of how the doctor's office ordered the test.

If you had a CT scan and nothing abnormal is noted, then celebrate your NEDness! If something did pop up, you would either have a PET scan or wait it out. For instance, I had a post treatment CT scan that indicated a new lung nodule, but it was small so a PET would probably not indicate FDG uptake, or "light up", so I repeated the scan three months later and the nodule was stable. Two years after, it was still stable.

So don't fret Carletta - celebrate your victory and completing chemo. And please, do follow up with your care and follow doctor's orders.

I hope this helped