Home Forums Melanoma: Stage III Insurance coverage and CAT scan vs PET scan

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    In November, I began the process to get my 2 year PET scan scheduled. ( I was actually 2 months overdue for it.) At the time, I was covered by HIRSP because the insurance coverage through my new job was not yet available due to a 90 day waiting period.

    Anyway, HIRSP refused to cover a PET scan because they did not feel it was “medically necessary.” They did agree to cover a CAT scan, though. Or at least whatever costs weren’t covered after my $2,500 deductible. I had the scan done and, thankfully, it showed no concerns of any kind.

    A couple of questions: Has anyone else had a similar situation with HIRSP? And: should I feel good about nothing showing up on the CAT scan or nervous that there might have been something revealed on a PET scan?

    I was not impressed with the way HIRSP handled their denial. They sent a letter to the doctor saying that they didn’t consider a PET necessary, and that they refused to entertain any “peer to peer” discussion on the matter. I found out through a phone call from the hospital. I was told by the hospital that I could petition HIRSP to have the PET done, but I had not even received a copy of the letter yet. By the time HIRSP sent a copy of it to me, I had only a couple of days before the Christmas holiday to make a petition and, with my HIRSP insurance expiring on Jan. 1, it just didn’t make any sense to try to get them to reconsider since the clock would probably run out on my coverage before they ever got around to making a decision.

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