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ins denied petscan - ???? all research shows it sb done
High kappa/lambda ratio is 34.; kappa free light is 26.5; high lgG 2360; AG Ratio .08; alpha globulins all high. Dr said need petscan along with the bone marrow; skeletal ct and doing a chest ct as nodules found in lung - why would ins deny petscan - all web searches show needful and protocol;
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I of course don’t know who your insurance company is or why they might deny a PET/CT but, I do know what happened to a few members of my own family including my husband. The PET was denied until there was an official diagnosis to merit it. In my husbands case, after he had the bone marrow biopsy that confirmed multiple myeloma the oncologist ordered the PET and it was approved.
Have you had the bone marrow biopsy yet?
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2 ReactionsI get the bone marrow biopsy on 7/24. The pet is slatted for 7/25 and the CT's the 25th as well. Thank you for your input.
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1 Reaction@puzzled211 While it's great to have gotten all these appointments scheduled so close together and in such a timely fashion, I agree with @auntieoakley. Many times there are specific steps along the way, and results need to be logged in before the next test. It is frustrating, isn't it?
Ginger
I just had a Pet scan at NYP on Saturday 7/12, my insurance which is Cigna Medicare covered it ( just had copay of $ 300.00. In 2021 & 2023 also had Pet scans, my insurance at the time was Aetna Medicare who covered it (copay at the time was $250.00).
Coverage for Pet scans & MRI VARY from insurance companies. Was the place you wanted to have it done in network?
These are all questions I ask clients to determine there insurance coverage.
I SUGGEST YOU CALL YOUR INSURANCE COMPANY CUSTOMER SERVICE DEPT & ASK FOR REASON FOR DENIAL
Back after being diagnosed in Dec. ‘24 with WM, my insurance also denied my doctors request for a Pet Scan. They said they would allow a full body scan. And after that they denied the medicine my doctor wanted me on. So I had to go on something they approved of. I don’t get it either. Who are they to tell the professionals ‘NO’?
Network is important.
Start an appeal. It may be resolved before you need to do anything.
With Medicare Advantage the private for-profit "urge" is to deny and wait and see if inertia results. Ka-ching!
Only a small percentage of denials are even ever appealed.
Over 70% of appeals are OVERTURNED. This says to me "Appeal appeal appeal" Don't give companies your $$$