How To Get A PET Scan Covered By Insurance? Tutorial

Helen Skeates
Helen Skeates
12 min read

Insurance coverage for a PET scan: what are your options? Well, you’ll have to check with your insurance company about that note. Either way, you’ll spend less money out of your own pocket because they’ll cover some or all of it.

With a PET scan, which stands for positron emission tomography, doctors can look for problems with our organs, tissues, or chemical activity that aren’t obvious from symptoms alone.

Breast cancer and Alzheimer’s disease-affected areas of the brain can both be detected this way.

It’s understandable that you’re concerned about the cost, as PET scans are expensive. However, if you’re covered by insurance, you may relax and continue reading.

PET Scan

PET scans, also known as Positron Emission Tomography scans, are a type of medical imaging test used to identify several diseases, most notably cancer. The level of cellular activity in the body can be assessed using radiation.

How To Get A PET Scan Covered By Insurance? 3 Easy Ways To Get Yourself Insured! - Krostrade

When conducting a PET scan, there are two basic types: Myocardial Perfusion PET (also known as Rubidium or Adenosine) and FDG PET (also known as Fluorodeoxyglucose).

Radiation from a tracer can be used to see specific parts of the body in PET scans. Medical specialties such as neurology and cardiology frequently make use of this scan. Complementary tests like MRI and CT can also be used in conjunction with PET scans.

Getting Insured

Insurance coverage for a PET scan: what are your options? Because it is a medical necessity, your insurance company may pay for a PET scan if your doctor orders one. Your insurance coverage will depend on the sort of policy that you have. Regardless of whether the insurance has a deductible, coinsurance, or a copayment component.

#1. Deductible insurance

Insurance policies that contain a deductible are based on the amount of premiums you have paid each year. Before you may use the advantage, you must pay a certain amount of money. Only once you’ve paid the premiums for a particular period of time will you be able to begin funding your own treatment.

#2. Coinsurance

When you have to pay a portion of the treatment costs out-of-of-pocket before receiving insurance coverage, you have to have coinsurance. You must cover at least 20% of the treatment costs out of pocket if you have Medicare insurance.

#3. Co-payment

A co-payment insurance has a defined sum that the insured individual is responsible for while receiving medical treatment. Medications are covered by Medicare in this scenario.


If your doctor has suggested a PET scan, it’s going to cost you a lot. For this reason, it’s a benefit to have insurance coverage. However, how do you plan to pay for it? PET scans are covered by insurance for the vast majority of people who need them. A commonality between them is that their insurance policies cover the cost of medical procedures.

Most health insurance coverage offer clinically necessary treatments such as PET scans. As a more advanced scan, a PET scan will be more costly to pay for out of cash.

You must first apply for insurance before you can get it. In order to ensure that you are eligible for the aforementioned protection, go over your insurance policy’s terms and conditions one last time. Consult with your insurance company to see if the scan in question is covered.

Depending on the terms of your insurance plan, you may be able to minimize the cost of your PET scans by having your insurance company cover a percentage or a portion of the cost.

Insurance Companies That May Cover PET

Some insurance companies may cover your PET scans, however I’ve provided two instances of firms that might. I’m not trying to promote any of these businesses; rather, I’m trying to give you an idea of what would work best for you.

#1. Medicare

When it comes to paying for medical expenses, Medicare is one of the federal programs available to you. All four portions are divided into four sections, referred to herein as parts A, B, C and D. Part A is primarily responsible for paying for inpatient hospitalization costs. Find out what Medicare and Medicaid are and how they differ from one another.

Part B is a medical insurance plan that includes medical supplies and a limited number of doctor’s appointments. Because it combines sections A and B with additional benefits, I favor Part C, which is known as the Medicare Advantage Program. Whereas Part D solely addresses the prescribed medication, it is a different story.

Medicare and PET scans: Coverage, options, and costs

Those who are eligible for retirement benefits should expect to pay between 260 and 480 dollars per year in premiums for the other aspects of the plan.

#2. Medigap

Medigap is yet another option for health insurance. Insurance provided by this company is designed to help pay for expenses not covered by Medicare. Deductibles, co-payments, and co-insurance are all included in this package.

Existing insurance doesn’t preclude you from obtaining a new policy. For financial reasons, many people have a slew of different life insurance policies. You’re welcome to join in. Medigap insurance is an example of this.

You won’t have to pay anything out of pocket if you choose one of their plans because they cover the extra costs that Medicare does not.

There is, however, one exception. Part B deductible is not included in the plans that Medicare must be paid for out of pocket, such as the three forms of insurance described above. As a result, having health insurance is really advantageous. Read up on what a master policy is in health insurance first if you’d like to use it.

PET Scan Cost Averages Around the Country

Specific PET Scan Procedures and National Cost Averages

Which factors can affect your PET scan cost?

Regardless of what kind of surgery you’re having, there are a number of variables that can effect the cost. Generally speaking, three variables contribute to the variation in healthcare costs:

  • The location of your medical procedure has an impact on the cost. Regardless of the sort of imaging scan your doctor has prescribed, inpatient procedures cost far more than outpatient procedures. Patients end up paying more since inpatient facilities are more expensive to manage.
  • Uninsured or insured—Medical procedures can be pricey, depending on the type of insurance you have. Depending on how much of the surgery is covered by your insurance, the cost can vary significantly. Without health insurance, you’ll be on the hook for the whole price of the surgery.
  • The cost of your medical procedure might be affected by where you live, including your region, state, and even city. It’s reasonable to expect to pay more in a rural place because there aren’t as many options as there are in a city. You can save money by having a medical treatment done while you’re away from your home.

Inpatient vs. outpatient facility cost differences

The price of a PET scan varies widely depending on whether the patient is an inpatient or an outpatient. There is a national average inpatient operation cost of $7,275, while the identical surgery at outpatient facilities costs $2,550.

Insured vs. uninsured cost differences

For PET scans, insured patients have generally paid less than uninsured patients, especially if they remain in-network at the hospital. Having insurance means that a patient and their insurer each bear a portion of the cost. With no insurance, the cost of a PET scan rests on the shoulders of the patient and hence is more expensive.

In-network vs. out-of-network cost differences

In-network is a term used to describe health care providers and facilities that have a set fee with a particular insurance firm. It’s almost always cheaper to use an in-network provider than an out-of-network provider, so this is a significant savings. If you don’t have insurance, you’ll be responsible for the entire expense of the medical procedure.

Payment responsibility

Almost everyone who undergoes a PET scan will be responsible for some of the costs. It is the responsibility of uninsured patients to pay the entire cost of their surgery.

There will be a deductible, co-pay, and co-insurance for patients who do not have health insurance coverage. Your health plan will have an impact on how much each of these items will cost.

More factors that affect your PET scan cost

  • Prescriptions – Before the procedure, a doctor may prescribe painkillers or a sedative. Make sure your drugs are covered by your insurance plan to prevent paying exorbitant fees for them. It’s possible to save money by asking if the identical medicine is available in a generic form.
  • An additional visit to the doctor’s office may be required before the treatment, and you may have to pay a fee for this. Your scan results will be discussed with you during a subsequent session, which will be scheduled shortly afterward. Inquire if the cost of the follow-up appointment is included in the overall procedure cost.

Your PET scan checklist

You should discuss with your doctor how much the procedure will cost in total. Keep a running tally of all of the expenses and have them explain why they are necessary. It’s good to know what to do if your medical cost is bigger than expected.

Ask your doctor if the treatment can be done in an outpatient facility.

Verify that all of your healthcare providers are part of your plan’s network. An anesthesiologist is an example of a physician who may be out-of-network. Ask your doctor if all of the providers who will be treating you are in-network for your insurance plan.

Under 1% of patients use this trick to save hundreds on medical bills

Finding a fair price for your PET scan

The national average cost of a PET scan is $5,750, yet the fair price is only $2,000 – less than a third of that amount. New Choice Health takes the guesswork out of health care by allowing you to compare facilities and make sure you’re getting the fair price for your procedure. Use New Choice Health’s comparison tool to save money on your PET scan.


The national average cost of a PET scan is $5,750, yet the fair price is only $2,000 – less than a third of that amount. New Choice Health takes the guesswork out of health care by allowing you to compare facilities and make sure you’re getting the fair price for your procedure. Use New Choice Health’s comparison tool to save money on your PET scan.

Despite the fact that the national average PET scan costs $5,750, a decent price for the procedure is just $2,000 With New Choice Health, you can compare medical facilities and ensure that you’re paying a reasonable price for your operation, taking the mystery out of health care. You can save money on your PET scan by using the comparison tool provided by New Choice Health.

Helen Skeates

Helen Skeates

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