A top nuclear imaging advocate on Thursday pushed back against Humana’s recent decision to refuse coverage for PET/CT exams, arguing the move denies patients access to potentially life-saving technologies.
The American Society of Nuclear Cardiology last week publicized Humana’s coverage determination, which restricts payment for hybrid PET/CT exams based on their “experimental” and “investigational” nature, according to the insurance giant.
But the Society of Nuclear Medicine and Molecular Imaging recently joined other medical groups, including ASNC, in trying to overturn the decision. Those organizations say such exams have an established role in treating a number of diseases, including esophageal cancers, neurologic abnormalities, and many cardiac indications.
“Nearly all commercially available PET scanners are now hybrid PET/CT systems, and these newer systems have numerous other improvements compared to older models,” SNMMI said in a statement. “With this policy, Humana is thus requiring its members to provide cardiac PET services using less advanced instrumentation than is currently available.”
Humana’s policy specifically states that its members may not be eligible for PET with concurrently acquired CT in many situations. Those include, but are not limited to cardiac, gastric or esophageal, and neurologic indications. Total-body PET/CT exams for screening, including cancer, may also be denied.
SNMMI also pointed to peer-reviewed literature and clinical appropriate use guidelines supporting the use of PET/CT, including backing from the Centers for Medicare and Medicaid Services and the American Medical Association.
“In summary, SNMMI strongly disagrees with Humana’s recently proposed policy decision to exclude hybrid PET/CT imaging for cardiac and several other indications as ‘experimental’ and ‘investigational,’" the group said in its statement. “Implementing this revised policy will deny patients access to state-of-the-art imaging procedures that are the standard-of-care for making potentially lifesaving clinical decisions.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.