Re: Pet Scans and Insurance Payment

[Guest guest]

Greetings Dawn,

PET scans cost approximately 4-6 times that of MRIs. A series of MRIs costs

between 400 and 600 (that was two or three years ago). So, a single PET

scan would cost in the range of 400-600 dollars.

No, most insurance companies will not pay for PET scans unless there is a

clear diagnostic need (or medically necessary). And frankly, other less

expensive tests can bring the diagnosis into a treatable range.

As an example, I might have PSP or MSA or just Sporadic OPCA or ... The

point is the treatment of all of these remains the same - treat the symptom,

not the disorder.

And disability and insurance covereage is determined based on the symptom,

not the disorder. Yes, a definite diagnosis can help. But not always.

So, I opted to avoid testing such as this unless something it can clearly

tell me what is wrong and how to fix the problem. In my case, that does not

appear to be warranted. Why? Because it feels that way for me. I did a

couple years of testing. It got very tiring.

Anyway, just my thoughts.

Regards,

=jbf=

B. Fisher

[Guest guest]

Greetings Dawn,

PET scans cost approximately 4-6 times that of MRIs. A series of MRIs costs

between 400 and 600 (that was two or three years ago). So, a single PET

scan would cost in the range of 400-600 dollars.

No, most insurance companies will not pay for PET scans unless there is a

clear diagnostic need (or medically necessary). And frankly, other less

expensive tests can bring the diagnosis into a treatable range.

As an example, I might have PSP or MSA or just Sporadic OPCA or ... The

point is the treatment of all of these remains the same - treat the symptom,

not the disorder.

And disability and insurance covereage is determined based on the symptom,

not the disorder. Yes, a definite diagnosis can help. But not always.

So, I opted to avoid testing such as this unless something it can clearly

tell me what is wrong and how to fix the problem. In my case, that does not

appear to be warranted. Why? Because it feels that way for me. I did a

couple years of testing. It got very tiring.

Anyway, just my thoughts.

Regards,

=jbf=

B. Fisher

[Guest guest]

,

I both agree & disagree with what you stated. I understand completely

that if a person is tired of testing and accepts what they have been Dx with

and trusts that their doctor has made the right Dx and they are satisfied

with the treatment & answers they have been given, then why get a PET scan.

It does take a lot of effort to get one since it is currently not included

in the " standard of care " for the majority of people with these types of

disorders.

But, if the person has odd symptoms, or is contemplating brain surgery or

something radical in the form of treatment, or feels like it might be

something else, or needs the peace of mind to know that their Dx is correct

so that they mentally can find the peace of being able to face it, then a

PET scan or a SPEC scan is warranted.

Yes, it is hard to get the Rx for one in the first place and Yes, it takes

effort to get your insurance to pay for it.... but I am a living example

that with this effort it can be done!

CIGNA, United Healthcare & Blue Cross/Blue Shield DO cover PET scans. For

something to be deemed " medically necessary " , all that requires is the

wording from the doctor on the Rx itself. Medicare/Medicaid does not cover

PET scans at this time. The request for them to be covered was brought

before the NIH and the US Congress back in August of 2000. Judgment was

passed in December of 2000 putting a 4 year moratorium of PET scans for the

general public, as far as coverage goes for Medicare/Medicaid... BUT it

agreed to funding the NIH to do research on neurodegenerative diseases by

using PET scans as the definitive modality on whether new neuroprotective

medications are working. The amazing thing that I found is that the NIH

studies have revealed in a couple of their studies that by using PET

technology, they were able to Dx certain neurodegenerative diseases in the

PRE-SYMPTOMATIC stage. I find this awesome and eagerly await the next time

this is brought before Congress in August 2004. The problem is, that may be

too late for some.

The F-DOPA scan, which costs the most, is a waste of time for anyone with

a PD+ type syndrome such as MSA, PCP, OPCA, etc. BUT, the FDG scan... which

ironically enough, costs the same, yes, costs the same as a MRI, can show

what the person has and though it might not change the original Dx or

treatment, it can bring peace of mine. Also, in some cases, like mine....

It can give the person their life back by showing that what they were being

treated for was incorrect and then they can be treated properly.

I guess it boils down to what the person wants to know and how it will

help them emotionally.

Hugs and Warm Fuzzies,

Deborah aka Tenacity

Personal website & photo's

http://www.pdhangout.com

http://community.webshots.com/user/tenacitywins

Reply-To: shydrager

To: <shydrager >

Subject: Re: Pet Scans and Insurance Payment

Date: Mon, 28 Oct 2002 16:45:40 -0500

Greetings Dawn,

PET scans cost approximately 4-6 times that of MRIs. A series of MRIs costs

between 400 and 600 (that was two or three years ago). So, a single PET

scan would cost in the range of 400-600 dollars.

No, most insurance companies will not pay for PET scans unless there is a

clear diagnostic need (or medically necessary). And frankly, other less

expensive tests can bring the diagnosis into a treatable range.

As an example, I might have PSP or MSA or just Sporadic OPCA or ... The

point is the treatment of all of these remains the same - treat the symptom,

not the disorder.

And disability and insurance coverage is determined based on the symptom,

not the disorder. Yes, a definite diagnosis can help. But not always.

So, I opted to avoid testing such as this unless something it can clearly

tell me what is wrong and how to fix the problem. In my case, that does not

appear to be warranted. Why? Because it feels that way for me. I did a

couple years of testing. It got very tiring.

Anyway, just my thoughts.

Regards,

=jbf=

B. Fisher

If you do not wish to belong to shydrager, you may

unsubscribe by sending a blank email to

shydrager-unsubscribe

[Guest guest]

,

I both agree & disagree with what you stated. I understand completely

that if a person is tired of testing and accepts what they have been Dx with

and trusts that their doctor has made the right Dx and they are satisfied

with the treatment & answers they have been given, then why get a PET scan.

It does take a lot of effort to get one since it is currently not included

in the " standard of care " for the majority of people with these types of

disorders.

But, if the person has odd symptoms, or is contemplating brain surgery or

something radical in the form of treatment, or feels like it might be

something else, or needs the peace of mind to know that their Dx is correct

so that they mentally can find the peace of being able to face it, then a

PET scan or a SPEC scan is warranted.

Yes, it is hard to get the Rx for one in the first place and Yes, it takes

effort to get your insurance to pay for it.... but I am a living example

that with this effort it can be done!

CIGNA, United Healthcare & Blue Cross/Blue Shield DO cover PET scans. For

something to be deemed " medically necessary " , all that requires is the

wording from the doctor on the Rx itself. Medicare/Medicaid does not cover

PET scans at this time. The request for them to be covered was brought

before the NIH and the US Congress back in August of 2000. Judgment was

passed in December of 2000 putting a 4 year moratorium of PET scans for the

general public, as far as coverage goes for Medicare/Medicaid... BUT it

agreed to funding the NIH to do research on neurodegenerative diseases by

using PET scans as the definitive modality on whether new neuroprotective

medications are working. The amazing thing that I found is that the NIH

studies have revealed in a couple of their studies that by using PET

technology, they were able to Dx certain neurodegenerative diseases in the

PRE-SYMPTOMATIC stage. I find this awesome and eagerly await the next time

this is brought before Congress in August 2004. The problem is, that may be

too late for some.

The F-DOPA scan, which costs the most, is a waste of time for anyone with

a PD+ type syndrome such as MSA, PCP, OPCA, etc. BUT, the FDG scan... which

ironically enough, costs the same, yes, costs the same as a MRI, can show

what the person has and though it might not change the original Dx or

treatment, it can bring peace of mine. Also, in some cases, like mine....

It can give the person their life back by showing that what they were being

treated for was incorrect and then they can be treated properly.

I guess it boils down to what the person wants to know and how it will

help them emotionally.

Hugs and Warm Fuzzies,

Deborah aka Tenacity

Personal website & photo's

http://www.pdhangout.com

http://community.webshots.com/user/tenacitywins

Reply-To: shydrager

To: <shydrager >

Subject: Re: Pet Scans and Insurance Payment

Date: Mon, 28 Oct 2002 16:45:40 -0500

Greetings Dawn,

PET scans cost approximately 4-6 times that of MRIs. A series of MRIs costs

between 400 and 600 (that was two or three years ago). So, a single PET

scan would cost in the range of 400-600 dollars.

No, most insurance companies will not pay for PET scans unless there is a

clear diagnostic need (or medically necessary). And frankly, other less

expensive tests can bring the diagnosis into a treatable range.

As an example, I might have PSP or MSA or just Sporadic OPCA or ... The

point is the treatment of all of these remains the same - treat the symptom,

not the disorder.

And disability and insurance coverage is determined based on the symptom,

not the disorder. Yes, a definite diagnosis can help. But not always.

So, I opted to avoid testing such as this unless something it can clearly

tell me what is wrong and how to fix the problem. In my case, that does not

appear to be warranted. Why? Because it feels that way for me. I did a

couple years of testing. It got very tiring.

Anyway, just my thoughts.

Regards,

=jbf=

B. Fisher

If you do not wish to belong to shydrager, you may

unsubscribe by sending a blank email to

shydrager-unsubscribe

[Guest guest]

Deborah,

What you stated is not accurate either, I have BC/BS (Trigon) and my

plan does not cover any test which is not Usual, Reasonable or

Customary. Therefore even if the doctor orders it - if Medicare decides

not to pay it - BC/BS does not have to pay it either.

Everyone MUST check ahead of time with your insurance company before

getting any unusual test. Here CIGNA has turned down tests (a Xray) for

a broken arm, good thing it was later determined that it was necessary

as the arm WAS broken, but the state medical insurance group finally

made them pay it after two years of legal fighting.. You can not make a

blanket statement that an insurance company will pay for any test just

because your doctor orders it, they do not. And if your doctor orders

it and the insurance company turns it down, the provider of the service

may have to eat the cost which drives the cost up for everyone. In

theory, Medicare will pay for PT and ST (they used to), but Medicare

(clerks and politicians) has decided to put more restrictions on

doctors, so if they continue to authorize it - they lose their Medicare

payments.

I do not know how or why your doctors did not catch your problem, but

there are no currently accepted operations for MSA to my knowledge. DBS

is only for PD patients and then only for specific reasons in the USA.

Are you continuing to improve? Have they given you any more indication

as to what your actual problem might be?

Take care, Bill Werre

Deborah Setzer wrote:

>,

>

> I both agree & disagree with what you stated. I understand completely

>that if a person is tired of testing and accepts what they have been Dx with

>and trusts that their doctor has made the right Dx and they are satisfied

>with the treatment & answers they have been given, then why get a PET scan.

>It does take a lot of effort to get one since it is currently not included

>in the " standard of care " for the majority of people with these types of

>disorders.

>

> But, if the person has odd symptoms, or is contemplating brain surgery or

>something radical in the form of treatment, or feels like it might be

>something else, or needs the peace of mind to know that their Dx is correct

>so that they mentally can find the peace of being able to face it, then a

>PET scan or a SPEC scan is warranted.

>

> Yes, it is hard to get the Rx for one in the first place and Yes, it takes

>effort to get your insurance to pay for it.... but I am a living example that

with this effort it can be done!

>

> CIGNA, United Healthcare & Blue Cross/Blue Shield DO cover PET scans. For

>something to be deemed " medically necessary " , all that requires is the

>wording from the doctor on the Rx itself. Medicare/Medicaid does not cover

>PET scans at this time. The request for them to be covered was brought

>before the NIH and the US Congress back in August of 2000. Judgment was

>passed in December of 2000 putting a 4 year moratorium of PET scans for the

>general public, as far as coverage goes for Medicare/Medicaid... BUT it

>agreed to funding the NIH to do research on neurodegenerative diseases by

>using PET scans as the definitive modality on whether new neuroprotective

>medications are working. The amazing thing that I found is that the NIH

>studies have revealed in a couple of their studies that by using PET

>technology, they were able to Dx certain neurodegenerative diseases in the

>PRE-SYMPTOMATIC stage. I find this awesome and eagerly await the next time

>this is brought before Congress in August 2004. The problem is, that may be

>too late for some.

>

> The F-DOPA scan, which costs the most, is a waste of time for anyone with

>a PD+ type syndrome such as MSA, PCP, OPCA, etc. BUT, the FDG scan... which

>ironically enough, costs the same, yes, costs the same as a MRI, can show

>what the person has and though it might not change the original Dx or

>treatment, it can bring peace of mine. Also, in some cases, like mine....

>It can give the person their life back by showing that what they were being

>treated for was incorrect and then they can be treated properly.

>

> I guess it boils down to what the person wants to know and how it will

>help them emotionally.

>

>Hugs and Warm Fuzzies,

>Deborah aka Tenacity

>

[Guest guest]

Deborah,

What you stated is not accurate either, I have BC/BS (Trigon) and my

plan does not cover any test which is not Usual, Reasonable or

Customary. Therefore even if the doctor orders it - if Medicare decides

not to pay it - BC/BS does not have to pay it either.

Everyone MUST check ahead of time with your insurance company before

getting any unusual test. Here CIGNA has turned down tests (a Xray) for

a broken arm, good thing it was later determined that it was necessary

as the arm WAS broken, but the state medical insurance group finally

made them pay it after two years of legal fighting.. You can not make a

blanket statement that an insurance company will pay for any test just

because your doctor orders it, they do not. And if your doctor orders

it and the insurance company turns it down, the provider of the service

may have to eat the cost which drives the cost up for everyone. In

theory, Medicare will pay for PT and ST (they used to), but Medicare

(clerks and politicians) has decided to put more restrictions on

doctors, so if they continue to authorize it - they lose their Medicare

payments.

I do not know how or why your doctors did not catch your problem, but

there are no currently accepted operations for MSA to my knowledge. DBS

is only for PD patients and then only for specific reasons in the USA.

Are you continuing to improve? Have they given you any more indication

as to what your actual problem might be?

Take care, Bill Werre

Deborah Setzer wrote:

>,

>

> I both agree & disagree with what you stated. I understand completely

>that if a person is tired of testing and accepts what they have been Dx with

>and trusts that their doctor has made the right Dx and they are satisfied

>with the treatment & answers they have been given, then why get a PET scan.

>It does take a lot of effort to get one since it is currently not included

>in the " standard of care " for the majority of people with these types of

>disorders.

>

> But, if the person has odd symptoms, or is contemplating brain surgery or

>something radical in the form of treatment, or feels like it might be

>something else, or needs the peace of mind to know that their Dx is correct

>so that they mentally can find the peace of being able to face it, then a

>PET scan or a SPEC scan is warranted.

>

> Yes, it is hard to get the Rx for one in the first place and Yes, it takes

>effort to get your insurance to pay for it.... but I am a living example that

with this effort it can be done!

>

> CIGNA, United Healthcare & Blue Cross/Blue Shield DO cover PET scans. For

>something to be deemed " medically necessary " , all that requires is the

>wording from the doctor on the Rx itself. Medicare/Medicaid does not cover

>PET scans at this time. The request for them to be covered was brought

>before the NIH and the US Congress back in August of 2000. Judgment was

>passed in December of 2000 putting a 4 year moratorium of PET scans for the

>general public, as far as coverage goes for Medicare/Medicaid... BUT it

>agreed to funding the NIH to do research on neurodegenerative diseases by

>using PET scans as the definitive modality on whether new neuroprotective

>medications are working. The amazing thing that I found is that the NIH

>studies have revealed in a couple of their studies that by using PET

>technology, they were able to Dx certain neurodegenerative diseases in the

>PRE-SYMPTOMATIC stage. I find this awesome and eagerly await the next time

>this is brought before Congress in August 2004. The problem is, that may be

>too late for some.

>

> The F-DOPA scan, which costs the most, is a waste of time for anyone with

>a PD+ type syndrome such as MSA, PCP, OPCA, etc. BUT, the FDG scan... which

>ironically enough, costs the same, yes, costs the same as a MRI, can show

>what the person has and though it might not change the original Dx or

>treatment, it can bring peace of mine. Also, in some cases, like mine....

>It can give the person their life back by showing that what they were being

>treated for was incorrect and then they can be treated properly.

>

> I guess it boils down to what the person wants to know and how it will

>help them emotionally.

>

>Hugs and Warm Fuzzies,

>Deborah aka Tenacity

>