Is My PET Scan Covered by Insurance

Is My PET Scan Covered by Insurance?

What is a Pet Scan?

PET scan stands for Positron Emission Tomography, an imaging exam that is designed to help reveal the way that the tissues and the organs are functioning. This is a medical diagnostic exam that requires the use of a small amount of radioactive material in order for this activity to be apparent. The type of radioactive materials and the specific delivery method of the material will depend on what tissue or organ the physician wants to examine using the scan.

Why is it Used?

PET scans are preferable to other types of scans such as MRI and CT scanning. This is because the scan will show how the tissues and organs are working rather than simply showing the structures of those organs and tissues. The most common situations where physicians may recommend a PET scan include: scans of the brain, the breasts, the heart and the lungs, though these are not the only areas where a PET scan may be recommended. 

What Conditions Does it Treat?

The PET scan can easily reveal the shape, size, position and function of a number of vital organs within the body. This test allows physicians to check on function of the brain, to diagnose brain disorders and cancers, to diagnose heart problems, to see how far a cancer has spread or to indicate areas of the body where the heart is not creating enough blood flow. Physicians may take PET scans over time in order to see how the body is responding to a treatment option when an illness such as cancer is present.

Does insurance cover PET scans?

Since a PET scan is high technology, it tends to be more expensive than other imaging techniques. However, it is one of the most effective methods for diagnosing various conditions and assisting with treatment plans.

Not all insurance policies cover PET scans, and some will only cover a PET scan for an existing condition. Review your policy or call your insurance agent to confirm whether or not your PET scan is covered by insurance.

Cost

For patients covered by health insurance, typical out-of-pocket costs would consist of coinsurance of 10%-50%. For example, at Dartmouth-Hitchcock Medical Center in New Hampshire, a patient with Medicare and no supplemental insurance could pay $1,500 for a whole-body scan. A PET scan is typically covered by health insurance, with some exceptions. For example, Aetna considers PET scans medically necessary for diagnosis and management of many cardiac conditions and many types of cancer; however, for certain conditions, such as cancers of the central nervous system, they are considered investigational and not covered.

For patients not covered by health insurance, a PET scan typically costs an average of about $4,900 for a PET scan of the whole body to $6,700 for the brain and $6,800 for the heart, according to NewChoiceHealth.com.

To avoid additional charges, patients need to ensure the radiologist is also in-network, otherwise their fees will need to be paid in full, not to mention those with large deductibles. Patients who haven’t met their yearly deductible yet will be likely billed the full procedure list price ($1,752 to $3,158.) because their insurance coverage will kick-in only after meeting the yearly deductible.

Almost 40% of all adult patients have high-deductible insurance plans, which means they need to meet their deductible of up to $13,000 per family before their insurance kicks-in. These patients can expect to pay the full price for the ultrasound ($138 – $1,514). For them, the best option is often to pay in cash. 

By forgoing insurance, self-pay patients can get a discount of up to 80% on their medical imaging scans. While many imaging centers offer cash pay discounts, it is best to contact them directly to make sure. Even then, there is no set guide to how much they will cost since pricing information is not often advertised and can vary based on many factors. Fortunately, Medmo takes the guesswork out of finding the best price for imaging scans. We match patients with centers that offer the most affordable rates for medical imaging at locations near them. 

To book a scan, visit us at Medmo.com. Medmo helps people schedule radiology imaging tests – such as MRI, CT scans, PET, and more – at nearby accredited centers and identify the payment solution that works best for them.

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