psma or axumin pet insurance /evicore denials.

So I've struck out multiple times on appeals for Axumin PET's on post prostatectomy cases. Evicore (via BCBS) telling me their policy is PSA must be > 1.0....even though NCCN guidelines now say do it for 0.5. I've had young guys with negative margin cases where I'm worried about small bony mets (PSA like 0.6) but I literally cannot look with modern imaging because I'm hamstrung. This is crazy to think that the standard of care imaging is not covered by insurance....but here we are... Read more
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Radiation Oncology Source Type: forums