Will pet insurance pay for pet scans?

A PET scan is a diagnostic test that doctors sometimes order to look for diseases like cancer or malfunctions in the brain or heart. While they’re fantastic tools to diagnose problems, they can also be expensive.

However, people with health insurance will have a much easier time paying for a PET scan. Whether through an employer-provided plan, private insurance, or Medicare, most plans will cover at least part of a medically necessary PET scan.

So, are PET scans covered by insurance? Read on to learn more about getting a PET scan covered by insurance, then compare quotes with multiple companies to find the best rate possible.

Does insurance cover PET scans?

Whether your health insurance will cover a PET scan depends on several factors. First, your physician must order the PET scan — PET scans are costly, and your insurance won’t pay for them just because you want one.

Another factor is the insurance company itself. Some insurance companies would cover PET scans if your doctor ordered one, while others will only cover tests for existing conditions or treating specific diseases like cancer.

For example, Aetna covers PET scans for cardiac conditions and several types of cancer. However, Aetna considers a PET scan investigational rather than medically necessary if you have a nervous system cancer. In that case, Aetna doesn’t cover a PET scan.

Even with insurance, PET scans can be expensive. The typical patient with health insurance will pay between 10% and 50% of the procedure.

If your doctor suggests a PET scan, check with your insurance company. PET scans can cost thousands of dollars, and you don’t want to be stuck with the bill.

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Does Medicare cover PET scans?

Like other health insurance providers, Medicare covers PET scans if a physician considers one medically necessary.

Medicare consists of two parts, covering different service types. The part covering your PET scan depends on where you get the procedure done. To get an idea of what might cover your PET scan, consider the parts of Medicare below:

• Medicare Part A. Part A covers inpatient services you receive at a hospital, including PET scans.
• Medicare Part B. Since doctors order most PET scans for outpatient care, Part B usually covers them. Part B covers doctor visits, diagnostic tests, and other outpatient services.
• Medicare Part C. Also known as Medicare Advantage, Part C is supplemental insurance that fills in the gaps from Original Medicare. Part C must at least cover what Original Medicare does, so a medically necessary PET scan is covered.
• Medicare Part D. Part D covers prescription medication and won’t help with a PET scan.

Medicare also covers other diagnostic imaging tests, including X-rays, MRI scans, ECGs/EKGs, and CT scans.

Unfortunately, Medicare doesn’t cover a PET scan for all types of cancer. Medicare only approves PET scans for the following types of cancer treatments:

• Colorectal cancer
• Breast cancer
• Lymphoma
• Melanoma
• Thyroid cancer
• Lung cancer (Non-small cell)
• Esophageal cancer

These are currently the only cancers for which Medicare will cover a PET scan. However, you might be able to get a PET scan covered by Medicare if your doctor insists that it’s medically necessary and your treatment can’t continue without it. (For more information, read our “What does pet insurance cover?“).

How to Get a PET Scan Covered by Insurance

Whether you have Medicare or private insurance, getting a PET scan covered through your insurance requires a doctor’s order.

If you have private insurance, check with an insurance representative before undergoing a PET scan. If you get one without checking first, you might get stuck with the full bill.

Another consideration is that some companies require that you get permission first before proceeding. If that’s the case, you might need to file paperwork requesting the PET scan. Your PET scan will likely get approved after a short waiting period.

What is a PET scan?

A positron emission tomography (PET) scan allows doctors to look inside your body and check for diseases or malfunctions.

PET scans use a special dye with a small amount of radioactive tracers. Depending on the body part getting evaluated, you either swallow, inhale, or have the dye injected. The dye gets absorbed by organs or muscles and then detected by the PET scanner.

A PET scan shows your doctor how the tissues and organs in your body are working. While they’re not as effective as a CT scan for seeing images of your insides, PET scans are one of the best ways to see how your body functions. A PET scan can see blood and chemical flows in your body.

PET scans are usually performed in an outpatient setting and take less than a few hours, meaning you won’t be down for the rest of the day.

Doctors often order PET scans for cancer, brain disorders, and heart problems. Although there is a minor risk of an allergic reaction to the tracer dye, PET scans are generally very safe.

How to Prepare for a PET Scan

PET scans are a relatively simple process, as they don’t take much preparation, and there’s nothing to concern yourself with after the procedure.

First, tell your scheduler the following information:

• Medication you take
• If you’re pregnant
• If you have diabetes

On the day of your appointment, follow your doctor’s instructions. They’ll likely include:

• Fasting before the appointment for at least six hours.
• Avoiding exercise.
• Arriving with the right forms, such as your insurance information, orders from your general physician, and previous diagnostic results.
• Wearing comfortable clothing.
• Giving yourself three hours at the appointment.

Your doctor may check your blood sugar before administering the tracer dye because glucose levels can affect the dye. You’ll have a short waiting period to let the dye spread; then, they’ll bring you into the scanning room.

You’ll have to lie still during the scan, but you’ll be free to return home and go back to your normal activities once complete. The dye will remain in your system for about 10 hours, though you can speed up the removal process by drinking water.

After your scan is over, a technologist will process the images, and a physician will look them over for any anomalies. Once the report gets generated, your physician will notify you of the results. If anything is awry, your physician will work with you to make a treatment plan.

Readmore: How do you become a pet insurance agent?

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How much does a PET scan cost without insurance?

The typical patient pays about $1,500 for a whole-body scan with insurance. That price will change based on your coverage, but you should prepare to pay about that much.

For people without health insurance, a PET scan can be costly. The typical PET scan costs about $4,900 for a whole body, $6,800 for your heart, and $6,700 for the brain. Of course, the price of your PET scan will change based on your location and the facility performing the procedure.

If you don’t have insurance, many medical providers offer discounts for patients paying in cash. Discounts range by facility but can be as much as 25%.

Find Health Insurance to Cover PET Scans

As you can see, insurance is crucial to finding an affordable PET scan. Whether you need private insurance or Medicare, the right policy can keep you covered for all your medical needs.

Finding the right health insurance policy might seem challenging, but it doesn’t have to be a struggle. To find the perfect policy at the best price, compare rates with as many companies as possible.

Case Studies: Understanding the Value: Case Studies Highlighting the Significance of Pet Insurance and Pet Scans

Case Study 1: Bella’s Coverage Dilemma

Bella, a five-year-old Labrador Retriever, needed a pet scan for a neurological condition. Sarah, her owner, had pet insurance but found out that the scan was not covered. Despite filing a claim, the insurance provider did not reimburse Bella’s pet scan expenses.

Case Study 2: Max’s Comprehensive Plan

Max, a nine-year-old Siamese cat, had been enrolled in a comprehensive pet insurance plan since he was a kitten. When Max developed symptoms indicating a potential brain tumor, his veterinarian recommended a pet scan to confirm the diagnosis. Max’s owner, Michael, contacted the insurance company and was relieved to find out that pet scans were covered under the comprehensive plan.

After submitting the necessary documentation, Michael received reimbursement for a significant portion of the pet scan expenses.

Case Study 3: Luna’s Pre-Existing Condition Clause

Luna, a three-year-old Golden Retriever, had a pre-existing condition related to her spinal cord. Her owner, Emily, had recently obtained pet insurance coverage for Luna and was unsure if pet scans would be included. Unfortunately, the insurance policy had a pre-existing condition clause, which stated that any conditions existing before the policy’s start date would not be covered.

As Luna’s spinal cord condition was pre-existing, the pet scan expenses were not eligible for reimbursement.

Case Study 4: Charlie’s Specialized Coverage

Charlie, a two-year-old French Bulldog, had a pet insurance policy that specifically covered specialized diagnostic procedures. When Charlie’s veterinarian recommended a pet scan to investigate an unknown ailment, his owner, David, contacted the insurance company to inquire about coverage. To David’s delight, the policy’s specialized coverage included pet scans.

After fulfilling the necessary requirements, David received full reimbursement for Charlie’s pet scan expenses.

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