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In order to avoid the unnecessary stress of getting your PET scans denied by the insurance company, pre-authorization is advised. The referring physician collaborates with the imaging center to verify specific local coverage guidelines and to obtain pre-authorization prior to performing the scan.
Some people experience the denial of the PET scan on the reason that "it wasn't medically necessary". It is recommendable to ask your doctor to write a letter of necessity indicating that the procedure could potentially provide the needed information for a diagnosis or for monitoring a known condition.
A PET scan can be approved or denied depending on several factors. One of them is the insurance plan. The costs of a PET scan can easily exceed 3- 4,000 USD, so the insurance company can take that into account when deciding to cover it or not.
Typically, most private insurance companies cover almost the same indications as Medicare. Companies may prefer CT scans as they are less expensive than PET scans. Most times, they might require a patient to have had a CT scan before approving coverage for PET scan.
We wanted a resource where people who are looking for better help can find it, because one of the issues that I have found is that the diagnosis takes a little bit, some people don’t know if they are diagnosed or not. This is something that it is important enough, that is why I wanted to put the information together.