Business course

Large private payer turns the tide on cardiac PET/CT coverage

One of the largest private health insurers in the United States has gone from considering hybrid PET/CT for “experimental/investigative” – ​​and therefore uncoverable – cardiac indications to being willing to pay for the modality, obviously. at the urgent request of two imaging associations.

The Society for Nuclear Medicine and Molecular Imaging released the change June 27, saying 39 million Aetna enrollees reversed course on PET/CT within days of SNMMI and the American Society of Nuclear Cardiology (ASNC ) sent the insurance giant a pointed letter.

“Failure to cover hybrid PET/CT deprives the patient of access to gold standard tests required to make vital clinical decisions,” SNMMI states in a press release conveying the gist of the letter. “The SNMMI and ASNC recommendations regarding the role of PET/CT in the evaluation of coronary artery disease have been accepted by the American Medical Association (AMA) RVS Update Committee (RUC) and multiple payers, including the CMS.”

SNMMI reports no direct response from Aetna but does tell SNMMI members:

We are pleased to communicate to our members that within days of receiving our letter, Aetna has rescinded its no coverage policy. SNMMI applauds this result and appreciates Aetna’s quick response.

Aetna, a CVS Health company, covers nearly 40 million people, according to the company.

Full SNMMI Announcement here.