Insurance denied petscan? All research shows it sb done, what next?

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?

I 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.

@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 $$$

Thank you everyone for your comments. The rush to get all the scans in - (reply to earlier post from someone) All of this has come about providentially - it is amazing to see how God worked just to get us to Mayo (completely for a diff situation - and this came out as a result). Our insurance thru my husbands company changes on 8/1 so we need to get this all in asap. Thankfully it has worked out. In response to another post - I have BCBS and they are the ones that denied my petscan :(. There is no place on their site for me to appeal but what I did was sent a message to the customer service section on our sign on acct for the website. ALSO - I asked that my dr do a peer to peer with insurance company. I do hope he gets it done before next week and things change. If not.....then I won't get a petscan. Thanks again.

I haven't had to yet, but my company has a good insurance rep that gets things done when I cannot. I know they will be there when I need them, and as someone just starting out with a ton of testing, I know there will be denials along the way. But possibly check with your husband's and your (if applicable) employer/HR dept to see if there is a direct rep for the insurances and get their contact info.

Putting this out there so anyone who has challenges getting things approved - this is what I found out today. BCBS did not deny but it was the 3rd party they use that denied my petscan. BCBS connected me to them and I explained my whole story - she said the dr did not even do a peer to peer with them. She said most likely they (3rd party) want more information like blood tests. She gave me their direct# and case ref# and I gave them back to the doctors nurse and asked them to make this happen. Perhaps the dr is so busy and did not take the time - I do not know but that is a bit frustrating. The response I got back was the skeletal CT scan sb sufficient along with the bone marrow biopsy.....but what I see on the web from Sloan Kettering Hospital and Cleveland Clinic and Mayo as well - is that the petscan is an integral part along with the BMB because it is possible that the spot they pull the biopsy from may not have the bad cells in that spot which is why a petscan is also needed as it sees all of the bones on in the inside. The skeletal CT shows if any lesions are on the bones on the outside.....SO. I have asked the doctors office to push this today as my insurance changes 8/1 and I need to know what I am dealing with. QUESTION - Am I being unreasonable....

Not at all!! You have informed yourself and need the scan. Your insurance company and provider are falling down on the job! How patients are supposed to navigate the problem and figure out how to get a claim on the right track- I will never understand. Gee whiz- I hope it all works out for you.