3 pet scans in your life

harleywiz
harleywiz Member Posts: 50

had a pet scan for nov 24th after haveing nodes removed from groin but becuse im on medicare with humana and medicade seems only 3 petscans in your lifetime

but unlimted cat scans this was part of the obama health care package

Comments

  • Lovekitties
    Lovekitties Member Posts: 3,364 Member
    Wondering

    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
    harleywiz Member Posts: 50

    Wondering

    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

    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

  • Lovekitties
    Lovekitties Member Posts: 3,364 Member
    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

    I found info from 2013

    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

  • fatbob2010
    fatbob2010 Member Posts: 467
    Caveat

    There always seems to be the caveat of "medical necessity.  PET Scans are hard for me to get as well and took some finesse by the surgeon, in my case (only had one in this lifetime). 

    My Oncologist has expressed that feels that CT Scans are adequate for anything he needs.

  • tanstaafl
    tanstaafl Member Posts: 1,300 Member
    snipe hunting considerations

    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.

  • hippiechicks
    hippiechicks Member Posts: 509
    I continue to have CT often

    I continue to have CT often .. have had many of them show false neg. and yet still have never had a PET.  

    My oncologist takes the same stand as many others here ... that the CT offers the best imaging.  

    I am not so sure .. 

    Another mate has recurred with false CT as well as MRI .... PET picked it up, but took several months to get one.

    Funny thing is .. I know several others with lower stage who have regular PET scans .. just don't get it honestly.

  • danker
    danker Member Posts: 1,276
    pet scans

    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!!!

  • janderson1964
    janderson1964 Member Posts: 2,215
    I had heard of that. I sm on

    I had heard of that. I sm on private insurance so ne more PET scans. I used to get thdm routinely on the same insurance but not any motr.

  • annalexandria
    annalexandria Member Posts: 2,571
    I'm not sure that the CT scan is really adequate in all cases

    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
    Betsydoglover Member Posts: 1,248
    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

  • Trubrit
    Trubrit Member Posts: 5,643 Member

    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

    Hello Betsy

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

    Sue - Trubrit

  • RickMurtagh
    RickMurtagh Member Posts: 586
    pet scans

    what do they know - same benefit - bsh.  pet scans are sooo cool.  way better than cat scans.  pet scans remind me of the encyclopedia britanica pages of the human body where you could flip the clear plastic pages and see all the bodies different systems!  

  • Dec201980
    Dec201980 Member Posts: 3 *


  • Dec201980
    Dec201980 Member Posts: 3 *

    I was diagnosed 6 years ago with lung cancer had one lung removed and radiation on the other they can't see if any cancer is growing due to scarring I have united healthcare dual complete and they just denied my pre-authorization

  • Dec201980
    Dec201980 Member Posts: 3 *

    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