Pet scan insurance coverage

Has anyone else had problems getting their insurance to pay for Pet scans?  We have Anthem Blue Cross, and they've been great about all my claims except the Pet scans.  I've had two thus far, and they denied both saying they were investigational for breast cancer.  My doctor sent a great letter with our appeal, and they've now agreed to pay for the first one, but are still denying the second one saying it's not medically necessary.  My doctor says they're wrong.  We have a second level of appeal to go to and will persue that.  Just wondering if anyone else has had to deal with this.  I'll have another Pet scan soon.

Hi,  Thanks for your reply!  I got a letter today from Bc concerning our appeal.  They explained that they will pay for the first Pet because it was medically necessary for diagnosis.  They are denying the second one because they considered it medically unecessary because I hadn't finished my course of treatment, and the doctor wasn't considering changing my treatment.  How did they know he wasn't?  My oncologist's insurance clerk did the research for me and wrote a letter which the doctor signed.  I sent the appeal myself, but I had to wait weeks for the letter.  I bugged her about it a lot which I hated doing.  I am somewhat encouraged since the next Pet coming up is after I've finished a course of treatment.  I just hope we won't have to appeal it to get it paid.  We'll still go to the second appeal on the second one.  Maybe all we need is a letter from the doctor saying he was considering changing treatment.  I, too, was asked for $500 down to get the second scan since they hadn't paid for the first.  They said they would take $100, but we paid the $500.  We've paid another $700 since then, and I hope we don't have to wait to get our money back if we ever get all the scans paid for.

I had no problem regarding my original PET, CT and Bone scans done before my mast, after my BC dx,  I had Health Net Insurance - at the time.

Since then I have had 4 sets of these scans (my normal -every 6 month scans) again, no issue. (Thank God)

The first 3 were still under Heath Net, however my husband's employer changed their provider to Anthem Blue Cross in March. Once again no issue when my May scans were requested.

I had a possible heart attack about 2 weeks ago and the ER Dr ordered another CT, as he was concerned with possible issues in my lungs. After waiting over 24 hours (maybe 36) to clear my system of the radioactive dyes, the treating doctor ordered another CT/PET with a drug induced stress test, again no issue regarding Anthem Blue Cross.

I am wondering if they will approve of my routine scans in November. I hope so cause I fear if Obama's health plan goes through, there will be no more scans for us BC patients and I want to,  at least, have one more.

My last scans showed lesions on my kidney, thyroid, sinus, mastoid, an area behind my eye, activity in my spine AND a number of mini-strokes. If I am denied, I hate to think of what will happen to me. At present I am seeing a neurologist, dematologist, eye surgeon, spine specialist plus my Onc , PCP, and pain clinic.

I have had injections in my spine 2 weeks ago, did not help, and will be having another set of them Thursday. Anthem Blue Cross approved 3 sets of these injections, and they are very expensive, so I wonder what they will or will not approve of next. They turned down my Dr's request to change my Gabapentin to Lyrica. Lyrica is a less dangerious drug but as it will cost $200 a month, I can't change.

I bet anthem Blue Cross is not happy with taking on me when my husbands company switch to them. My medical just since March is close or over $200,000. The CT/PETs have been over $30,000 a piece.

Please let us know what your outcome is. I live in Los Angeles.
Jean

WOW Susan your prices in the south are so much lower than in Los Angeles.
My last CT/PET scans cost, $35,769.29 !
My exchange surgery, $120,339.97
My chemos were over $30,000 each (I think around $37,000)
We thank God we had insurance.
I wish they would approve of Lyrica, so I could get off the Gabapentin.