› Forums › General Melanoma Community › pet/ct medicare denial
- This topic has 12 replies, 4 voices, and was last updated 9 years, 7 months ago by
JerryfromFauq.
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- October 12, 2014 at 9:21 pm
Does anyone know what can be done about this? My husband has been required each time to sign an ABN (Advance Beneficiary Notice that the scans likely won't be covered by Medicare) for his PET/CT scans. Medicare has always paid until this last one. I know there is a limit to how many they will cover so apparently that limit has been met and we now have to pay. Is there a way of appealing this denial and getting it paid by Medicare? Why does Medicare limit the number of PET/CTs a patient can have? What scans do they recommend instead of the 6 month PET CT? Thank you
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- October 12, 2014 at 10:19 pm
Hello,
I just ran into the same thing. I was having PET SCANS every 6 months.
My Doctor told me that insurance wasn't covering PET SCANS anymore but they will cover up to 3 CT's. I asked him what about if cancer is found again, and he said the first time it would be rejected, but if they push back on it, it will get approved.
He also told me that they just recently discovered that a PET SCAN shows no more than a CT SCAN, and the CT SCAN is much less radiation ( I disagree, but im not the expert). I have had 2 now with no problems.
Only 2-3 CT's are necessary per year now.
I hope this helps.
Stage 3B, NED since March
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- October 13, 2014 at 1:14 am
I dunno why your doc would say a PET SCAN shows no more than a CT SCAN. When all this started for me they did at least 2 or 3 CTs and 2 or 3 MRIs. The only thing the reports showed was in the T10 vertebrae. They thought that was all I had so they started radiation on the T10. Then they did the PET. Keep in mind this is all in a 2 week timeframe. The PET showed at least 9 tumors. Everything greater than 3 on than PET scale. Most were around 7 back then except the T10 was about 11 I think.
Soooo at least in my experience the PET SCAN shows way more than the CT. Granted all my tumors were in bone so maybe that is the difference. I dunno. Just thought I should mention my experience.
Artie
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- October 14, 2014 at 4:43 am
My husband has had 4 CTS, 1 MRI, and a Pet scan this calendar tear. He has Medicare senior advantage.
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- October 14, 2014 at 4:43 am
My husband has had 4 CTS, 1 MRI, and a Pet scan this calendar tear. He has Medicare senior advantage.
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- October 14, 2014 at 4:43 am
My husband has had 4 CTS, 1 MRI, and a Pet scan this calendar tear. He has Medicare senior advantage.
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- October 15, 2014 at 8:04 am
First thing to realize is that a PET scan does not show cancer. A pet scan shows the glucose uptake in tissue. Especially damaged tissue. it is famous for both false positives and false negatives. I have had many of both. I have had many injuries and surgeries, including oral surgery in my 71 years. My PET scans shows every one of those as a hot spot. Including all the melanoma surgeries i have had.
PET scan highlights do show starting points to be investigated They did find my deep inguinal and iliac melanoma groin nodes. They also missed a soft tissue groin melanoma two years later that I asked my surgeon to remove regardless of what the Pet and CT showed. I could feel it growing and it was putting pressure on a nerve or tendon It also missed a visible surface neck tumor I had at the same time. The new groin tumor was a big black Melanoma .
A PET scan, inspite of subjecting one to a higher dosage of radiation, does not have the fine resolution of a CT scan, so cannot be used to show the more exact dimensions of a tumor that is need to tell growth or reduction. I have not had a PET scan in 5 years. I am not NED and have innumerable lung tumors which have been followed by CT scans which have varied from monthly to bi-monthly to quarterly to bi-yearly and now to yearly.
In 2008 Blue Cross reduced the number of PET scans they would cover without a fight and the other Insurance companies quickly jumped on the bandwagon, so then Medicare decided they would to. MRI's must be used to watch for brain metastases since the brain is one big hot spot on a PET, due=e to the huge amount of blood (Therefore a huge amount of glucose in it.)
If one has a lump or a pain then it is easier for ones oncologist to push for and justify an additional scan. (I didn't say that!).
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- October 15, 2014 at 8:04 am
First thing to realize is that a PET scan does not show cancer. A pet scan shows the glucose uptake in tissue. Especially damaged tissue. it is famous for both false positives and false negatives. I have had many of both. I have had many injuries and surgeries, including oral surgery in my 71 years. My PET scans shows every one of those as a hot spot. Including all the melanoma surgeries i have had.
PET scan highlights do show starting points to be investigated They did find my deep inguinal and iliac melanoma groin nodes. They also missed a soft tissue groin melanoma two years later that I asked my surgeon to remove regardless of what the Pet and CT showed. I could feel it growing and it was putting pressure on a nerve or tendon It also missed a visible surface neck tumor I had at the same time. The new groin tumor was a big black Melanoma .
A PET scan, inspite of subjecting one to a higher dosage of radiation, does not have the fine resolution of a CT scan, so cannot be used to show the more exact dimensions of a tumor that is need to tell growth or reduction. I have not had a PET scan in 5 years. I am not NED and have innumerable lung tumors which have been followed by CT scans which have varied from monthly to bi-monthly to quarterly to bi-yearly and now to yearly.
In 2008 Blue Cross reduced the number of PET scans they would cover without a fight and the other Insurance companies quickly jumped on the bandwagon, so then Medicare decided they would to. MRI's must be used to watch for brain metastases since the brain is one big hot spot on a PET, due=e to the huge amount of blood (Therefore a huge amount of glucose in it.)
If one has a lump or a pain then it is easier for ones oncologist to push for and justify an additional scan. (I didn't say that!).
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- October 15, 2014 at 8:04 am
First thing to realize is that a PET scan does not show cancer. A pet scan shows the glucose uptake in tissue. Especially damaged tissue. it is famous for both false positives and false negatives. I have had many of both. I have had many injuries and surgeries, including oral surgery in my 71 years. My PET scans shows every one of those as a hot spot. Including all the melanoma surgeries i have had.
PET scan highlights do show starting points to be investigated They did find my deep inguinal and iliac melanoma groin nodes. They also missed a soft tissue groin melanoma two years later that I asked my surgeon to remove regardless of what the Pet and CT showed. I could feel it growing and it was putting pressure on a nerve or tendon It also missed a visible surface neck tumor I had at the same time. The new groin tumor was a big black Melanoma .
A PET scan, inspite of subjecting one to a higher dosage of radiation, does not have the fine resolution of a CT scan, so cannot be used to show the more exact dimensions of a tumor that is need to tell growth or reduction. I have not had a PET scan in 5 years. I am not NED and have innumerable lung tumors which have been followed by CT scans which have varied from monthly to bi-monthly to quarterly to bi-yearly and now to yearly.
In 2008 Blue Cross reduced the number of PET scans they would cover without a fight and the other Insurance companies quickly jumped on the bandwagon, so then Medicare decided they would to. MRI's must be used to watch for brain metastases since the brain is one big hot spot on a PET, due=e to the huge amount of blood (Therefore a huge amount of glucose in it.)
If one has a lump or a pain then it is easier for ones oncologist to push for and justify an additional scan. (I didn't say that!).
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- October 13, 2014 at 1:14 am
I dunno why your doc would say a PET SCAN shows no more than a CT SCAN. When all this started for me they did at least 2 or 3 CTs and 2 or 3 MRIs. The only thing the reports showed was in the T10 vertebrae. They thought that was all I had so they started radiation on the T10. Then they did the PET. Keep in mind this is all in a 2 week timeframe. The PET showed at least 9 tumors. Everything greater than 3 on than PET scale. Most were around 7 back then except the T10 was about 11 I think.
Soooo at least in my experience the PET SCAN shows way more than the CT. Granted all my tumors were in bone so maybe that is the difference. I dunno. Just thought I should mention my experience.
Artie
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- October 13, 2014 at 1:14 am
I dunno why your doc would say a PET SCAN shows no more than a CT SCAN. When all this started for me they did at least 2 or 3 CTs and 2 or 3 MRIs. The only thing the reports showed was in the T10 vertebrae. They thought that was all I had so they started radiation on the T10. Then they did the PET. Keep in mind this is all in a 2 week timeframe. The PET showed at least 9 tumors. Everything greater than 3 on than PET scale. Most were around 7 back then except the T10 was about 11 I think.
Soooo at least in my experience the PET SCAN shows way more than the CT. Granted all my tumors were in bone so maybe that is the difference. I dunno. Just thought I should mention my experience.
Artie
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- October 12, 2014 at 10:19 pm
Hello,
I just ran into the same thing. I was having PET SCANS every 6 months.
My Doctor told me that insurance wasn't covering PET SCANS anymore but they will cover up to 3 CT's. I asked him what about if cancer is found again, and he said the first time it would be rejected, but if they push back on it, it will get approved.
He also told me that they just recently discovered that a PET SCAN shows no more than a CT SCAN, and the CT SCAN is much less radiation ( I disagree, but im not the expert). I have had 2 now with no problems.
Only 2-3 CT's are necessary per year now.
I hope this helps.
Stage 3B, NED since March
-
- October 12, 2014 at 10:19 pm
Hello,
I just ran into the same thing. I was having PET SCANS every 6 months.
My Doctor told me that insurance wasn't covering PET SCANS anymore but they will cover up to 3 CT's. I asked him what about if cancer is found again, and he said the first time it would be rejected, but if they push back on it, it will get approved.
He also told me that they just recently discovered that a PET SCAN shows no more than a CT SCAN, and the CT SCAN is much less radiation ( I disagree, but im not the expert). I have had 2 now with no problems.
Only 2-3 CT's are necessary per year now.
I hope this helps.
Stage 3B, NED since March
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