How to get insurance approval for regular follow up scans?

Danny, 

I think it depends on your diagnosis stage of cancer. I am 3B cancer free 2 years now after 1 year of chemo. I get CT scans every 12 weeks and will over the next 3 years. My understanding at my stage and period of cancer free I should only be permitted every 6 months and was hopeful to get on that schedule. I am on a Clinical trial and the drug company pays for my treatment and scans but the hospital still gets approval from my insurance BCBS 701 surgical PPO. 

I do not think it is approved to get PET scans more than once a year. I am not sure you want a PET scan every 3 or 4 months because it is a very high dose of radiation to your body. You should ask your DR why he wants a new PET so soon? See if you can just get CT scans and MRI of your brain once a year. 

Tom 

As a stage IV patient, yes, we have regular scan routines. My scans are CT's of the chest/ab/pelvis, once every 3-4 months. I've had brain metastasis as well, so brain MRI's are once every 2 months (they were, at one point, every 3-4 weeks!). I've only had 2 PET's in the last 4 years. PETs are generally very expensive and unnecessary. I have noticed that many stage III patients are scanned with some regularity too… but not sure what the frequency is… and if it is considered "standard care" by insurance coverage "rules".  Has your oncologist's office tried running a CT approval through instead? Also… is it a location issue as reason for denial? My insurance forces me to have CT's done locally, then I carry my image disc down to my docs for follow up visits in Los Angeles. 

I am stage 4a and have PET scans every 3 months. I know some say this is too many too close together, but the last one in April picked up four new tumors in my leg, hip, and lower back that were not visible in the January scan. My insurance at first declined the last one in April but then OK'd it after my doctor asked for a CAT instead. Go figure. Insurance companies are strange and stubborn animals and sometimes I think it depends on who is reviewing the request if it gets approved or not. I know that doctors can file appeals when scans are denied, so maybe yours will want to do that. 

As for MRIs, I have had 3 of my brain in the nearly 2 years since my last diagnosis. (I switched doctors and hospitals about 6 months in, so that's why 3 and not 2.) 

Good luck to you as you continue to fight this tenacious disease.