PET scan denied by insurance (Avmed)

Laughing Gull, you were Her+, which the OP is not. That's a whole different situation. I think PET scans are pretty rare, unless the diagnosis absolutely warrants one, or the insurance policy is very liberal in what it pays for.

I have had a PET scan denied and when I questioned it I found out that they had contacted the oncology office to do a "peer to peer" review first. The insurance company had a doctor on staff who wanted to confer and determine the reasoning behind the request for a PET scan. Once I asked them to contact them again, I contacted oncology office to advise them they would be calling and it was critical they talk to them or the PET scan ordered could not be completed. That extra call to both did the trick and I was approved and scheduled. Make sure to use an approved facility though.

Ah ha. I believe that is an abdominal CT and maybe covering the esophagus. I don't believe this will target breast tissue. Never the less, if you don't drink the stuff, they can't pick up what's happening on their scanners.

They told me no non breast scans because mri did see anything in nodes. Insurance won't pay. I was so upset. The system is broken and crazy. I had pains in my side. I threw a tantrum so they ordered CT's and bone scan. No pet. Insurance approved bone denied CT's. Did a peer review and got it approved. I had to drink a lot of yucky stuff. It was horrible.Pet sees it at a smaller molecular level and/or different so I'm still upset I didn't get one. I would drink the stuff. Why get the scan and not follow recommendations.

Oral contrast is pretty standard for abdominal CT. It makes the GI tract stand out which helps them diagnosis. I had the CT and bone scan because of a positive node. It sucks to drink it, but at the end of the day, it's only a moment in time and then it's over. I say if you're going to get the test, just do it and let it be accurate. They're looking for mets. You're going to want that to be as accurate as possible, otherwise you could end up with unnecessary additional testing if they see something they're not sure about.

I get it, it sucks. I got diarrhea from it, but honestly it's not the end of the world.

MinusTwo, some CT scans use both. Mine last week did.

ScatteredEnergy if you really want a complete picture, then you'd be better served to get your CT with and without the contrast dye. The dye was a very small amount in water, and didn't even discolor the water. I'm pretty picky with texture aversions and the only issue I had was they used cold water which I dislike. So bottoms up for a better view.

Edited to add it was two small water bottles, so max 24 ounces.

I've had CT without contrast prior to the lumpectomy (because my MO wanted a more thorough check of my lungs since I was still a smoker then). That scan picked up a kidney cancer, so I get regular post-nephrectomy CT scans with contrast (chest, abdomen, and pelvis). The MO schedules those, but says they would NOT ordinarily be done for a breast cancer patient after surgery unless symptoms or blood tests warrant it. I had one PET scan earlier this year, again at the request of the urologist but scheduled by the oncologist. The MO explained that PET scans aren't usually used for checking the brain because it looks for sugar uptake, and the brain has more sugar than other organs. Although my insurance approved it due to my multi-cancers, I had to pay nearly $1,000 out of pocket. Those suckers are incredibly expensive. Brain mets are usually found with an MRI (per my MO and also my friend who has had brain mets), not a PET.

Edj3, glad your pesky little passengers are benign. Just keep up with ultrasounds or scans as ordered. I have no idea if mine developed from something non-cancerous or if it was nasty from the start. It was 7 cm when found, so it had been there a while - and even that's not considered huge for a kidney cancer, just on the cusp of stage 1 & 2. Wishing you a very healthy New Year!