Topic: PET scan coverage

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Posted on: Mar 17, 2011 10:41AM

Posted on: Mar 17, 2011 10:41AM

sflow wrote:

My doctor has ordered a PET scan for me for Sept when I will be close to being 5 yrs out of IDC.  Since I don't have symptoms, what are the chances that my insurance will cover this?  I have Highmark. 

Dx 11/15/2006, IDC, Right, <1cm, Stage IA, Grade 3, 0/4 nodes, ER+/PR+, HER2-,
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Mar 17, 2011 03:40PM AnneW wrote:

You might be able to find it on your insurance company's website, in their list of exclusions.

Maybe someone who knows Highmark will have a more concrete answer.

2002 IDC stage 1, grade 1, rads & AI Dx 9/18/2007, ILC, <1cm, Stage I, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Mar 17, 2011 03:49PM sflow wrote:

Thanks--I hope someone knows.  The onc nurse said not to bother calling Highmark as the customer service people really don't know.  She said she cannot call to authorize till a month before.

Dx 11/15/2006, IDC, Right, <1cm, Stage IA, Grade 3, 0/4 nodes, ER+/PR+, HER2-,
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Mar 17, 2011 05:20PM christine47 wrote:

I work in a medical office (not oncology), often times insurance companies seem to work very hard at denying coverage for anything they can get away with.  Certainly they are not shy about taking your premiums though.  I would insist they pay for it, if they deny you might tell them that you want a letter from their medical director assuring you that he will take responsibility if you are later diagnosed with breast cancer related disease/ reoccurance or mets.  We all know the value of early diagnosis.  Usually authorizations are obtained a month before the scan, and have an expiration date, so the nurse is probably correct on this.  Hope this helps!  I just had a second PET scan within 8 weeks of my 1st, my onc was not sure if it would be approved (it was), if it had not been, I would have protested big time. 

Dx 11/11/2010, IDC, 1cm, Stage IIA, Grade 2, 1/17 nodes, ER+/PR+, HER2-
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Mar 17, 2011 06:09PM sflow wrote:

Thank you, Christine.  I will take that into advisement--so true, those companies are glad to take our premium payments, but sadly, they are not always good about coverage. 

Dx 11/15/2006, IDC, Right, <1cm, Stage IA, Grade 3, 0/4 nodes, ER+/PR+, HER2-,
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Mar 17, 2011 07:16PM Juli50 wrote:

Last December, my insurance (Aetna) denied my Pet Scan. My onc immediately contacted them and they approved it. I get the feeling that the insurance companies are just trying to see if you really want it.

Juli

4 AC, Taxol 8 wks + Herceptin 11 wks, CHF from Herceptin, rads, osteoporosis, Tamoxifen 9/19/09 - 05/18/11, re-started Tamox 6/18/11 Dx 7/7/2008, IDC, 2cm, Stage IIA, Grade 2, 0/1 nodes, ER+/PR+, HER2+

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