What does it take to get a PET scan?

Ladyfuzzy

 I was almost to my 7yr mark when the mammogram came back positive. I had a biopsy of the sentinel lymph node and it is also positive. I've decided on yet another mastectomy but my I would like to get a PET scan as I'm very scared that the cancer has gone to other organs (my 1st mastectomy had 1 pos lymph node). My surgeon says she has been turned down by insurance for every PET scan she has wanted. Are they really that  "unnecessary"? Anyone have similar hardships trying to get one?

Gitane

My insurance paid for a PET for me before surgery and treatment.  It was part of my staging process.  I don't understand why the surgeon can't get one scheduled.  Perhaps an oncologist would have more influence?  Just don't know.  Hope others can help who know more.

NancyD

I'm waiting to hear if my insurer will OK a PET/CT for me next month. It's been a year since my surgery, and although I don't have any specific symptoms, we all know that this beast can creep up on you and settle somewhere witihout too many early warning signs.

My onc's office didn't seem to think it would be any biggie to get approval. I hope they're right

pitanga

Ladyfuzzy, first of all I am so sorry to hear of your recurrence. I went through a similar diagnosis earlier this year, after 9 years with a clean slate. So I know what a shock it is.

When they found my recurrence, they immediately sent me for a bone scan. Three areas lit up and so then they sent me for MRIs, which said that 2 were likely to be arthritic but that the third was probably a metastasis. My insurance refused to cover a PET/CT but I went ahead and did it anyway, paying out of pocket. It confirmed the MRI's tentative findings, so here I am, officially stage IV. Sigh. I also had a sonogram followed by a CT scan of my abdomen but they showed nothing suspicious.

I live in Brazil, so what my insurance plan covers probably has little relevance to you, but even in the states I suspect that different health plans may have different coverages. But maybe your onc could start by sending you for less expensive tests, and if these come back with suspicious areas, use that to justify sending you for the PET.

 Best of luck to you,

Lisa

Skyrat

Maybe it's the way your doc is requesting.  When my onc requests a PET/CT Scan, it is always for restaging.  I have heard though, a lot of docs and insurance companies don't like paying for PET/CT Scans because of the false positives.  IMHO, I'd much rather the false positives than false negatives!

cp418

Maybe the order/request must come your oncologist instead of your surgeon?  I also had a PET scan done when I was initially diagnosed to determine staging.  What I have trouble getting done is MRI which Insurance refuses to approve.

lovinmomma

I got a PET to stage me, but my insurance will not pay for a PET to screen me until I have a bone scan or something else that shows something and then they will pay. Your onc can fight with the insurance companies but many are just routinely dismissing repeat PET's. Have them list it as a staging PET and if they refuse fight it. If they still rtefuse ask for a bone scan and go from there.

rdrake0

I asked my first onc for a PET/CT scan and he said I didn't need it.  So he wouldn't have tried at all with my insurance.  My second onc said yes and insurance paid for it and a repeat PET/CT 6 mos later.  I do think it depends on your insurance company, though.