Insurance Denial for PET Scan

This topic has 12 replies, 8 voices, and was last updated 5 years, 8 months ago by aldrichdesigner.

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- September 13, 2018 at 4:38 pm
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Savymoo23
Participant
GAHHHHHH my stupid insurance denied my doctors request for a PET scan because I'm only stage 2B. BLAH. Looks like they are going to do CT scans with contrast? Does a CT even compair too a PET scan? I'm so frustrated.

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- - September 13, 2018 at 5:23 pm
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  Johnjk04
  Participant
  Good day Savannah – yes insurance companies are not always working for your complete benefit. I am a stage IV patient, melanoma in the brain and almost all of my organs. Smilow – Yale New Haven has never given me a PET scan. They are very confident of the CT scans w/ contrast and when needed the brain MRI. I feel that you will be alright without the PET scans.
  - September 24, 2018 at 12:13 pm
    
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    aldrichdesigner
    Participant
    
    John, I am in the same boat. They don’t even order PET scans. They are very expensive and insurance always wants to fight them when they get the same info and results from a CT with contrast and MRI of brain.
    
    Now it’s possible that they may want a PET if they see something and for some reason want to go back and confirm with a different test. It would be hard for your insurance to say no at that point.
- - September 13, 2018 at 5:30 pm
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  bjeans
  Participant
  What Celeste once said when asking her about what scan for what body part:
  
  “Most melanoma big dogs prefer to have CT's of body and MRI's of brain. PET's light up too easily to mean a great deal. Usually those who have a PET that shows something have to have a follow-up CT to determine if there is anything they really need to worry about. PET's light up anywhere there is glucose uptake…which in the human body…that is the brain ALL the time and lots of other places for a wide variety of reasons!”
  
  Hang in there –
  
  Beth
- - September 13, 2018 at 7:28 pm
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  Edwin
  Participant
  Since your melanoma was Clark level V, a PET scan would be justified. A PET scan would probably cost much less than your sentinel lymph node biopsy did. Shame on your health insurance company.
  
  In August 2014 I had a PET scan, before I had a sentinel lymph node biopsy. My dermatologist requested this PET scan. If my melanoma had spread to a distant organ, a sentinel lymph node biopsy would not have been helpful. I have had a PET scan every 4 months for the 3 years that I have had stage 4 melanoma. My most recent PET scan was on September 5. My health insurance paid for all my PET scans.
  
  A PET scan does not show brain cancer, because the brain always shows as active in PET scans.
  - September 13, 2018 at 11:06 pm
    
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    bjeans
    Participant
    
    It doesn’t sound like it’s being suggested that a SLNB is being used instead of scans, just that instead of a PET, a CT would be done. And I thought Breslow is used rather than Clark.
    
    (My husband did have a PET, CT and MRI before his SLNB and WLE, and gets scans every three months since he’s part of a study, but the PET was only done once and not part of the study.)
- - September 13, 2018 at 7:49 pm
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  guynamedbilly
  Participant
  I had to switch to CT from Pet for my last few scans. As I understand it PET makes it harder to miss cancer because it lights up very obviously, and it can show a little more detail than a ct in some cases. That said, CT scan shows plenty of detail if the doctor reviews it well enough. I had a recurrence earlier this year that was missed by a pet scan, then biopsied, then showed up on the CT scan.
  
  I wouldn't be too terribly worried about getting a CT instead.
- - September 13, 2018 at 9:02 pm
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  doragsda
  Participant
  In addition to what everyone else said above, a PET involves a radioactive tracer injection, so it poses a slightly higher risk in the long term. It would be good to have a MRI of the brain in addition to the CT scans, but that doesn't seem to be the standard of care at stage 2B. My wife was 2B and wound up with two brain mets 6 months after being declared NED after her WLE and SLNB. I still wonder if a MRI at the time would have found one or both of those mets 6 months earlier.
- - September 13, 2018 at 9:38 pm
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  Edwin
  Participant
  My PET scans include low dose CT for attenuation correction and anatomic localization purposes. The CTs show suspicious areas, which are not cancer because the PET does not show them as active. A CT scan done without PET could show false positives.
  
  If a PET scan or CT scan shows a new suspicious area, a biopsy can be done to determine whether it is cancer. My March 2015 PET scan showed activity in a rib. A biopsy of it showed only normal bone. My August 2015 PET scan showed more activity in that rib. This time a biopsy showed melanoma in that rib. Melanoma was probably there in March 2015.
  - September 13, 2018 at 10:57 pm
    
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    bjeans
    Participant
    
    “A CT scan done without PET could show false positives.”
    
    I thought what Celeste/Bubbles was saying (quoted in earlier post) was kind of the opposite – that PETs can be too sensitive so even if they light up, a CT would need to be done.
    
    Curious about Ed’s take.
  - September 13, 2018 at 11:23 pm
    
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    Edwin
    Participant
    
    A PET scan can show that a suspicious area is not cancer. From the CT part of my recent PET scan:
    
    "Calcified pulmonary granulomata. Additional stable noncalcified pulmonary nodules. Biapical scarring. Non-FDG avid lymph nodes or prominent vascular structures in the upper abdomen. Multiple healed rib fractures. Stable healed bilateral inferior pubic rami fractures.”
    
    These are not cancer, because they are not active in the PET scan. My lung scarring may be due to the pneumonia I had in December 1975. Most of my bone fractures were caused by melanoma. All my bone cancer seems to be gone. I do have cancer under my left jaw.
  - September 17, 2018 at 1:49 pm
    
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    cancersnewnormal
    Participant
    
    CT's can show lumps and bumps that will not light up as cancer on a PET. However, PET's can light up areas of inflammation or infection which are not cancer. Sooooooo… either modality can show a "false positive" and require a good eye from radiology.
    
    As for Savymoo's issue………… a CT with contrast is standard, slightly less damaging to your body (the contrast material is a bit less toxic), less expensive (what insurance is seeking), and will show enough detail to note "areas of concern" which may require a closer look, such as a PET or biopsy.
- - September 14, 2018 at 6:58 pm
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  WithinMySkin
  Participant
  Hi Savannah! Insurance companies aren’t the nicest when it comes to approving scans. If your doc really wants a PET, they can send them a letter trying to get it approved. My docs do a PET/CT scan – meaning when I go in for a scan, we do a PET and then a CT scan with the same machine. The PET scan can have false positives (as stated before) so it’s good to compare it to a CT scan. PET scans can see what’s metabolically active, while CT scans have a better clarity of picture to see if things look malignant. I have a few blobs in my lungs and a benign tumor near an ovary called a teratoma. They could see these things on a CT scan, and used the PET to determine that they had no ‘uptake’ and so they weren’t cancer.
  
  If they see anything unusual on the CT, they may then have you go in for a PET and that would definitely be approved by insurance at that point. But a CT is PLENTY good at finding anything unusual! Wishing you clear scans!!