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PET/CT scans

Posts: 12
Joined: Oct 2011

I was concerned about my insurance company refusing to cover my upcoming post treatment PET/CT scan. I called the cancer center where I have my treatment. I was pleasantly surprised to find out that the cancer center had already gotten pre-authorization from my insurance company. I feel a lot better now.

mp327's picture
Posts: 4121
Joined: Jan 2010

That's how my PET/CT's have been handled in the past. The hospital never called me to schedule unless and until they got authorization. However, I always called my insurance company after I got scheduled to make sure they had the correct date(s), which was usually a range, to include the date on which I would have the scan. Once they made an error and had the wrong dates, which would have created a real headache for me, had I not called. I would encourage you to just give your ins. co. a call and verfiy that the date you are to have the scan is in their records. I wish you great results on your scan!

z's picture
Posts: 1407
Joined: May 2009

That's one less thing to worry about. I have been fortunate that my scans are always pre approved and I get notices from my insurance company in the mail. Yet, the 1st notice is always a dis approve and the next is an approved. I think they hope I won't follow through, but my dr gets it fixed.

Posts: 242
Joined: Feb 2011

Many insurance companies don't authorize the use of PET CT due to cost and the fact that the cancer community does not recommend PET CT for routine surveillance ... See the NCCN guideline for info on follow up recommendations. Frankly there are no standard recommendations re; scanning post treatment.

Now I'm not an expert on all this but these are my thoughts;

PET CT is quite expensive and there are arguments that low tech scans do the same thing essentially. See the link below from Blue Cross and Blue Shield. Now keep in mind this is an insurance company, however they use the NCCN recommendations (cancer experts) to support their decisions as well.

However, the NCCN is unlikely to recommend PET CT as "standard of care" due to the cost and lack of availability of this High Tech scanning approach in certain communities. And I don't think there have been large clinical trials that provide evidence of the value of PET CT as a "standard" approach to surveillance. Therefore many insurance companies don't authorize its "routine" use. But, I'm not an expert on all this ... sadly a consumer.

See below ...


Personally, I want a PET CT as my follow-up. I want that fused PET with CT to show any enlargement of nodes, tumor growth and/or uptake of isotope to identify early issues. I also want a radiologist who reads these things day in and day out to interpret the outcome and an oncologist and colo rectal surgeon who will act decisively on the results. Thus .... a facility that deals with anal cancer as a routine part of their practice. That being said, MAJOR cancer center's that treat anal cancer routinely do CT alone vs. PET CT. Some don't scan at all and the "standard of care" supports that approach. Now on another issue ... this all has to be balanced against our exposure to the radiation from a PET CT every 3 months ... radiation also causes cancer! Geez ... what do we do? Make the best decision we can given the information we have at the time. A good discussion with your oncologists.

Ok ... off my soap box now.

mp327's picture
Posts: 4121
Joined: Jan 2010

You've made some very good points about PET/CT. There are advantages and disadvantages. One disadvantage of PET scans is that they are so very sensitive, thus increasing the chances of a "false positive." Things such as inflammation show up quite often on PET, registering with an SUV. I've had this happen several times and it always leaves me a little shaken. I question how the reading radiologist knows the difference between inflammation and abnormal cells. On the flip side, I have a friend who is a radiologist and he has often told me that sometimes things are seen on PET scans that are missed on CT's. I believe the main reason PET's are not allowed in a lot of instances has to do with cost.

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