Shirlee Zerkel: A question on coverage for PET scans for pre-Medicare retirees and an answer from Sandy Knoesel

Shirlee Zerkel to John Curry, September 7, 2007
Subject: Fwd: Health question

I hope that both my question Ms. Knoesel and her reply get through to you. To me this was an important question and her answer is worth hanging onto if any of us would need such tests. I know I am going to file this little tidbit. But I can clearly see MM. or Aetna trying to get out of paying for multiple tests per year. Can't you/?

Shirlee

Sandy Knoesel to Shirlee Zerkel, September 7, 2007

Subject: RE: Health question

Good afternoon. I have taken a few extra days to respond to your e-mail because I wanted to provide some additional information. Currently, there is no limit for PET scans for cancer patients. Both Aetna and Medical Mutual base requests for this service on medical necessity and have extensive policies that are used in administering this benefit. Predetermination of coverage by the provider is recommended before the performance of this procedure.

Sandy Knoesel

Shirlee Zerkel to Sandy Knoesel, September 2, 2007
Subject: Health question

I have a question concerning health care testing. If an STRS retiree not yet on Medicare was found to have a cancer that required frequent PET scans, how many such scans would either Aetna or Medical Mutual pay per year?

Shirlee Zerkel