How to get insurance approval for regular follow up scans?

Posted By
MovingOn
5/18/2017 5:51pm
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Replies: 6

It seems to be typical that melanoma patients get regular PET scans every three months (then decreasing to 6 month intervals). I was just turned down by my insurance company for a scan 4 months after my resection surgery. Is this typical to get declined by insurance for a proactive regular scan?

Can anyone provide insight on how my Oncologist can get the scan approved by insurance?

(my insurance is good, Aetna Signature PPO, and has never turned anything down until now)

Thank you!

Danny

Diagnosed Jan 2017 (stage 3b with unknown primary). Radical neck dissection Feb 2017 (4 positive nodes in level 5A). Ipi started Mar 2017 - ended May 2017 (Hypophysitis), recurrence Sep 2017 (node by ear)

Danny, 

I think it depends on your diagnosis stage of cancer. I am 3B cancer free 2 years now after 1 year of chemo. I get CT scans every 12 weeks and will over the next 3 years. My understanding at my stage and period of cancer free I should only be permitted every 6 months and was hopeful to get on that schedule. I am on a Clinical trial and the drug company pays for my treatment and scans but the hospital still gets approval from my insurance BCBS 701 surgical PPO. 

I do not think it is approved to get PET scans more than once a year. I am not sure you want a PET scan every 3 or 4 months because it is a very high dose of radiation to your body. You should ask your DR why he wants a new PET so soon? See if you can just get CT scans and MRI of your brain once a year. 

Tom 

As a stage IV patient, yes, we have regular scan routines. My scans are CT's of the chest/ab/pelvis, once every 3-4 months. I've had brain metastasis as well, so brain MRI's are once every 2 months (they were, at one point, every 3-4 weeks!). I've only had 2 PET's in the last 4 years. PETs are generally very expensive and unnecessary. I have noticed that many stage III patients are scanned with some regularity too... but not sure what the frequency is... and if it is considered "standard care" by insurance coverage "rules".  Has your oncologist's office tried running a CT approval through instead? Also... is it a location issue as reason for denial? My insurance forces me to have CT's done locally, then I carry my image disc down to my docs for follow up visits in Los Angeles. 

Thank you. Maybe I should instead be getting CT scans on a regular basis rather than PET scans. I'll ask my Oncologist about that at my next appt.

Diagnosed Jan 2017 (stage 3b with unknown primary). Radical neck dissection Feb 2017 (4 positive nodes in level 5A). Ipi started Mar 2017 - ended May 2017 (Hypophysitis), recurrence Sep 2017 (node by ear)

I also have Aetna.  I am stage III.  So far they have allowed me to have a Pet Scan and six months later a Cat Scan.  I am one year out.  Landecope16 

 

I am stage 4a and have PET scans every 3 months. I know some say this is too many too close together, but the last one in April picked up four new tumors in my leg, hip, and lower back that were not visible in the January scan. My insurance at first declined the last one in April but then OK'd it after my doctor asked for a CAT instead. Go figure. Insurance companies are strange and stubborn animals and sometimes I think it depends on who is reviewing the request if it gets approved or not. I know that doctors can file appeals when scans are denied, so maybe yours will want to do that. 

As for MRIs, I have had 3 of my brain in the nearly 2 years since my last diagnosis. (I switched doctors and hospitals about 6 months in, so that's why 3 and not 2.) 

Good luck to you as you continue to fight this tenacious disease.

Christine P. 

Sorry - that should say "since my first diagnosis." Just wanted to clarify that. 

Christine P.