How Do I Get An Insurance Coverage For A PET Scan?

How to get a PET scan covered by insurance? Well, you will have to check that note with your insurance provider. Whether they can cover it fully or partially, either of them will reduce your expenses coming out of your pocket.

A PET scan, or positron emission tomography scan, is a modern medical imaging procedure used to detect abnormalities in our organs, tissues, and even our chemical function that cannot be diagnosed by symptoms alone.

It could also indicate breast cancer or parts of the brain that are affected by Alzheimer’s disease.

Regardless, you might be worried about the cost, which I understand because PET scans cost a lot. But if you have insurance, rest assured that they will help you with your expenses. Read on!

PET Scan

The Positron Emission Tomography Scan, sometimes known as a PET Scan, is a diagnostic used to diagnose certain medical disorders, most notably cancer. Radiation can be used to examine a body’s cellular activity level.

The PET scan is divided into two types; the Myocardial Perfusion PET, also known as Rubidium or Adenosine PET, which is mainly used in cardiac examinations, and the FDG PET, which concentrates on infectious diseases in critical areas.

Both types of PET scans use a radioactive tracer to see specific areas in the body for examination. The said scan is generally used in medical areas such as neurology and cardiology. PET scans can also be combined with MRI, magnetic resonance imaging, or a CT scan.

The Technology Behind a PET Scan

Positron Emission Tomography is what PET stands for. Using radioactive material, a PET scan can help detect a multitude of diseases as well as help determine one of the best methods of treatment. Sometimes a PET scan is assisted by a CT scan, which stands for Computed Tomography.

A CT scan can sometimes be superimposed over the PET scan to allow for additional views. CT scans do not use radioactive material, although they can sometimes use material such as barium or iodine in addition to specialized X-ray equipment.

Getting Insured

How to get a PET scan covered by insurance? Generally, a PET scan may be covered by your insurance since it is a medical necessity if requested by your doctor.

The coverage of insurance will depend on what type of insurance you have purchased. Whether it is deductible, a Coinsurance, or a Co-payment type of insurance.

Deductible insurance

A Deductible type of insurance is based on the annual amount of premiums you have paid. You must spend an amount of sum before you could avail of the benefit. After a year or a certain period of paying the premium, that’s the only time you could start to fund your treatment.

2. Coinsurance

Coinsurance is a type of insurance that you have to pay a percentage of the treatment cost before availing of the insurance coverage. For most Medicare insurance, you will have to self-fund at least 20% of the treatment expense.

3. Co-payment

A Co-payment insurance has a fixed amount to be paid by the insured person when receiving medical treatments. Medicare, in this case, covers prescription drugs and medicines.

Qualifications

Having a PET scan requested by your doctor can be quite expensive. That’s why having insurance to cover it is an advantage. However, how will you get it covered?

Most insured people who undergo PET scanning are covered by insurance. One thing they have in common is that their insurance policy covers prescribed medical treatments.

Most health care insurances cover clinically indicated treatments such as PET scans included in their policies. However, since PET scan is a higher level of technology, it will be expensive to cover it from the pocket.

Insurance is the key, but you have to apply for it first. Then, to qualify for the said coverage, check or re-read the terms and conditions of your insurance policy. You could also ask your insurance provider if the said scan is under the policy.

Your insurance company may or may not cover your PET scans but there may be certain conditions that could somehow reduce your expense like covering a percentage or a portion of it.

The Benefits of a PET Scan

The benefit of a PET scan is the non-invasive technology used to detect various illnesses and problems within the body. A PET scan is administered via intravenous injection and requires no surgical procedure.

In addition to detecting cancer, a PET scan can detect if cancer has spread to other parts of the body. It can also help determine a treatment method and then later be used to see if cancer has returned.

Other than cancer detection and treatment, a PET scan can be used to check for abnormalities of the brain. Brain abnormalities such as memory disorders, tumors, or even seizures, can be detected this way.

People with certain heart conditions or risks can also benefit from a PET scan. For example, a PET scan can be used to determine if you need an angioplasty; or it can be used to determine how your heart is functioning post-heart attack. Even the blood flow of your heart muscle can be easily detected with a PET scan.

Insurance Companies That May Cover PET

Several insurance companies could give you health care coverage, but I have here 2 examples of companies that may cover your PET scans. I am not advertising the said companies but giving you an idea of what would best suit your needs.

1. Medicare

Medicare is one of the federal health insurance programs that could help you cover your health-related bills. They have 4 parts, namely: parts A, B, C, and D. Part A mostly covers hospital care expenses.

Part B is medical insurance with medical supplies and some doctor appointments with their affiliated health care providers. Part C is the Medicare Advantage, which I prefer since it combines parts A and B with additional benefits. In contrast, Part D concerns only with the medicine or drugs prescribed.

When it comes to paying the premiums, Part A is a premium–free plan while the other parts should have a range of 260 to 480 dollars premium fees that includes retirement benefits to those who are qualified.

2. Medigap

Another insurance company is Medigap. It is a medical insurance company designed to cover additional costs that Medicare insurance can’t cover. It includes the deductibles, co-payments, and co-insurance mentioned earlier.

If you already have health care insurance, it doesn’t mean you can’t have another. Many people have multiple life insurance plans to help them cover their expenses. You can follow them too. That is the case with Medigap insurance.

Since it covers the additional fees that Medicare can’t cover, its plans could cover the other expenses so that nothing will come out of your pocket.

However, there is an exception. The plans that Medicare requires to be paid out-of-pocket, including the 3 types of insurance mentioned above, do not include the Part B deductible.

Therefore, health insurance is really beneficial. If you want to avail yourself, read first what is a master policy in health insurance.

Summary

If you are wondering how to get a PET scan covered by insurance, all you can do is check with your health care insurance provider if it is covered under the policy coverage.

If your insurance provider could not cover all of the expenses, you could have an extra insurer to back up the other expenses, as Medicare and Medigap insurance do.

Also Read:

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  7. What Is the Cost of Private Mortgage Insurance (PMI)?
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  10. What is Renters Insurance and How Does it Work?

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