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PET scan denied by insurance — how to appeal

Sarah Chen, RN-BSN, CPCSarah leads InsureDefense's clinical review. 12 years working appeals at a major US payer plus 4 years as a patient advocate.

About PET scan

PET scan denials commonly involve oncology indications where the insurer's reviewer applies criteria narrower than NCCN guidelines. The strongest appeals cite the relevant NCCN section and attach the oncologist's clinical reasoning for the specific cancer type and stage.

Common reasons PET scan gets denied

  • Prior authorization not in place
  • Cancer staging criteria not met under plan rules
  • Imaging not required by NCCN guidelines for the specific indication

Evidence that helps overturn a PET scan denial

  • Oncologist's clinical letter
  • Tumour board notes if applicable
  • NCCN guideline citation for the specific cancer and stage

Recommended approach

For most PET scan denials, our triage will recommend the Premium Appeal ($499) tier. We prepare a professionally-structured appeal that addresses the specific denial reason, cites the relevant clinical evidence, and meets your insurer’s appeal-rights deadlines. Treatment cost exposure: typically $1,500–$7,000.

What to do next

  1. Find your denial letter (or EOB) and check the appeal deadline.
  2. Upload it to InsureDefense for a free triage — no payment required to see the assessment.
  3. If you choose to proceed, you’ll receive a draft within 24 hours (12 hours for urgent cases).
  4. Submit the appeal to your insurer using the fax / portal / mailing address we provide.
  5. Track the insurer’s response using our 14/30/45-day follow-up reminders.

Upload your PET scan denial See pricing

Frequently asked questions

What's the most common reason PET scan gets denied?
Prior authorization not in place
How long do I have to appeal a PET scan denial?
Under federal law you generally have 180 days from receiving the denial notice to file an internal appeal. The exact deadline is on your denial letter. If the treatment is time-sensitive you may qualify for an expedited appeal, which must be decided within 72 hours.
What's a PET scan treatment typically cost?
PET scan costs vary by plan, region, and provider, but typical out-of-pocket exposure when denied is $1,500–$7,000.
What tier do you recommend for a PET scan appeal?
For most PET scan denials we recommend the Premium Appeal ($499) tier — but our free triage will confirm or adjust based on your specific case.
Not legal, medical, or insurance advice.

InsureDefense is not a law firm, insurer, medical provider, or claims adjuster. We do not provide legal, medical, or insurance advice. We prepare appeal documents based on the information you provide. We do not guarantee approval, payment, coverage, or reimbursement. For urgent medical situations, contact your doctor, insurer, or emergency services directly.