Does private insurance pay for PSMA (Pylarify) scans in the US

[TJGuy]

Has anyone had the Pylarify PSMA pet scan in the US and had it paid for by private insurance (not medicare) such as and especially BCBS.

Does any one know the cost of these scans in the US, have you actually been billed for cash payment or insurance cost.

Again same two questions for Galium 68 PSMA pet scan.

[fireandice123]

I had a PSMA scan in May that was paid by BCBS. They initially denied it and required new CT and bone scans before they would pay for it. My MO said they wanted those scans and a PSA of 1.0 or higher before they would pay for PSMA. My PSA was 0.9 but they went ahead and paid.

I don’t know yet how much they billed BCBS. I understand the costs can vary a great deal depending on location, type of facility, etc.

[tango65]

The cost is variable depending on the Institution doing the scan. They usually charge around $ 20,000 to Medicare.

[j-o-h-n in reply to tango65]

I just see them sitting around Medicare Headquarters..... Playing poker and laughing their asses off.....$20,000 = chickenfeed.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/25/2022 3:01 PM DST

[tango65 in reply to j-o-h-n]

I just got the bill for a Pylarify and a FDG PET/CT, just chicken feed $ 44,000.Medicare covered most of it.

[j-o-h-n in reply to tango65]

To quote Dr. MLK, "Mostly free at last, mostly free at last".....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/25/2022 3:18 PM DST

[leebeth]

UHC readily paid for my husband’s last December.

[Bvilkid]

I had one yesterday- Community Care in Oklahoma only charged a $250 copay.