No PETs Allowed



12/12/12 didn’t mark the end of the world, but it has marked the beginning of the end the great health insurance policy I have. Just as I figured, people with individual health insurance policies like mine get screwed by the Patient Protection and Affordable Care Act (PPACA). I’ve had my health care plan for over 10 years now, and It’s provided great coverage at a very affordable price, and, up until today, my insurance company had never denied a procedure.

My six month PET scan was scheduled for tomorrow, but the insurance denied covering the PET scan, and approved a CT scan instead. I got a letter from the insurance company yesterday authorizing the CT san, so I called the Cancer Center to see what was going on —  it turned out the doctor who is standing in for my oncologist while she is on sabbatical hadn’t yet found out that the PET scan had been denied. So I was transferred to the receptionist in Radiology who explained that when the denial came in, the doctor on call cancelled the PET scan so I would not be liable for a $9000 procedure, and scheduled the CT scan. My new doctor was out of town, so he hadn’t learned about what happened.

Here’s the issue: if I did a CT scan it would show I have a bunch of tumors. The tumors are dead, killed by the chemotherapy I finished two years ago, but the CT scan will not show if there is any new, cancer-like activity; whereas a PET scan will show if there are any “hot spots” that could be cancerous. The doctor did say that the radiologist can use a CT scan to measure and compare lymph nodes from my previous PET scan, but he went on to say that I should have symptoms and the blood work would probably indicate if there were issues with lymph nodes having significant growth over the past six months. My blood work was normal, and I currently don’t have any symptoms to speak of.

The doctor called my insurance company this morning and argued for a PET scan, but they held firm in their denial. With the new rules that require insurance companies to use something like 80% of the premiums on patient care and other changes coming into effect from the PPACA, my insurance company changed its policy to only cover one PET scan a year, once a patient has gone two years from being diagnosed with cancer and successfully treated.  But they will authorize CT scans since they are much cheaper than PET scans, and argue that CT scans are sufficient preventative procedures. In my case a CT scan is more of a problem than a preventative procedure, so we cancelled the CT scan, and we will see what the doctor can negotiate in January, since it’s a new calendar year.

The lead photo is one of the images from my PET scan done on this day last year. The second photo is the Rail Runner streaking by at the Alameda crossing, and the third photo is a car covered with Christmas lights speeding up Paseo Del Norte throwing off square roots of light.