[Stann]

PET scan experimental?

by Stann on Mon Dec 14, 2015 4:53 pm

I've had 4 PET scans over last 6 years and Blue Shield has always approved of coverage.
Currently blood work and BMB indicate I'm relapsing. PET scan would be very valuable at this stage.

This insurance company has been great to me during my 6 year multiple myeloma Odyssey.
any ideas as to why they now call it experimental and are denying coverage?

[Multibilly]

Re: PET scan experimental?

by Multibilly on Mon Dec 14, 2015 6:05 pm

Have your doc appeal directly on your behalf. This worked for me when my insurance denied my last PET/CT.

You need to read your insurance company's bulletins and detailed certificate of coverage to see what they consider to be covered versus experimental. If you can't find it, simply ask your insurance company for the supporting documentation on the subject.

[Eric Hofacket]

Re: PET scan experimental?

by Eric Hofacket on Mon Dec 14, 2015 6:05 pm

PET scan experimental? That does not sound right. When does something go back to being experimental? My HMO will do very few things that are experimental and they are still doing a lot of PET scans. This does not sound right at all and it sounds like they are making some kind of mistake in understanding in your case or are intentionally jacking you around to not have to pay for it.

[Stann]

Re: PET scan experimental?

by Stann on Mon Dec 21, 2015 7:36 pm

It's a PPO plan that I've had for my 6 years of myeloma. They've never questioned anything, including 3 prior PET scans. It was denied when my local oncologist asked (on appeal). So my myeloma specialist at UCSF asked for PET scan--same response.

I'm hoping this isn't an indication of how I'll be treated by the insurance company when seeking to use any of the newer treatments that have been approved lately.

Thanks for your replies. MB--I'll ask for the documentation--thanks.