Insurance companies deny PET scan claims most often because the scan was not ordered by a veterinarian, was performed at an out-of-network facility, or the condition itself falls outside your policy's coverage

A PET scan (positron emission tomography) is an imaging test that shows how tissues and organs are functioning, not just their structure. It costs between $2,000 and $5,000 and is used to detect cancer, neurological disease, and organ dysfunction. Pet insurance companies deny these claims for specific, documented reasons — and most denials can be prevented by understanding your policy before the scan is ordered.

The three most common reasons for denial are: the veterinarian did not refer the scan as medically necessary, the facility where it was performed was not in your insurer's network, or your policy excludes the condition being investigated. A fourth reason — that you did not meet your deductible or hit your annual limit — is less common but still happens. Knowing which applies to your situation is the first step to either getting the claim paid or avoiding the denial in the first place.

Key Takeaways

  • PET scans are denied most often because they were ordered without a veterinary referral, performed out-of-network, or the condition is excluded from your policy.
  • Your policy may require pre-approval from the insurance company before the scan is performed, and skipping this step almost always results in denial.
  • Some policies cover PET scans only when ordered by a board-certified specialist, not a general veterinarian.
  • Out-of-network facilities charge more and insurers may deny the claim entirely or pay only a percentage of what an in-network facility would have charged.
  • Calling your insurer before scheduling the scan — not after — is the fastest way to confirm coverage and avoid a surprise denial.

Pre-approval requirements and how they cause denials

Many pet insurance policies require pre-approval before a PET scan is performed. This means your veterinarian must contact the insurance company, describe the medical reason for the scan, and receive written approval before the appointment is scheduled. If your vet orders the scan without this step, the insurer will deny the claim even if the scan was medically necessary and your policy would have covered it.

Pre-approval serves two purposes for the insurer: it confirms that the scan is not routine or elective, and it gives the company a chance to ask for additional information — such as previous test results, the pet's age, or whether other diagnostic methods were tried first. Some insurers use this information to deny the claim before the scan happens, which saves you from paying out of pocket and then fighting for reimbursement.

Your policy documents will state whether pre-approval is required. If you cannot find this information, call your insurer's customer service line and ask directly: "Does my policy require pre-approval before a PET scan?" Write down the answer and the date you called. If the answer is yes and your vet did not get approval, you can sometimes appeal the denial by submitting the pre-approval request retroactively, though approval is not may provide.

Out-of-network facilities and reduced or denied reimbursement

Pet insurance companies maintain networks of veterinary hospitals, specialists, and imaging centers. When you use an out-of-network facility, the insurer may deny the claim entirely, reimburse you at a lower percentage, or pay only what an in-network facility would have charged for the same service.

For example, an in-network PET scan facility might charge $3,000, and your policy covers 80 percent of that — so you pay $600. An out-of-network facility charges $4,500 for the same scan. The insurer may pay 80 percent of $3,000 (the in-network rate), leaving you responsible for $3,900 instead of $600. Or the insurer may deny the claim outright and tell you that PET scans are only covered at in-network locations.

Before your veterinarian refers you to an imaging center, ask whether it is in-network with your insurer. Your insurer's website usually has a searchable directory, or you can call and ask. If the only facility available is out-of-network, contact your insurer before the scan to ask whether they will cover it and at what percentage. Get the answer in writing if possible.

Conditions and diagnoses your policy may exclude

Pet insurance policies list conditions they will not cover. These exclusions vary widely by insurer and by policy tier. Some policies exclude cancer screening entirely, others cover it only if the pet has symptoms, and still others cover it only for pets under a certain age.

A PET scan ordered to investigate possible cancer in a senior dog may be denied if your policy excludes cancer in pets over 10 years old, or if it excludes preventive screening (scans done before symptoms appear). Similarly, a PET scan to evaluate cognitive dysfunction in an aging cat may be denied if your policy excludes neurological conditions or age-related decline.

Read your policy's exclusions section before you need imaging. If a condition is excluded, the insurer will deny any claim related to that condition, regardless of how medically necessary the scan was. If you are unsure whether your pet's condition is excluded, call your insurer and describe the symptoms and the reason the vet wants the scan. Ask directly: "Will my policy cover a PET scan for this condition?" Do not assume the answer based on the policy name or marketing materials.

Deductibles, annual limits, and claim timing

Even if your policy covers PET scans and you meet all other requirements, the claim may be denied or only partially paid if you have not met your deductible or if the scan pushes you over your annual benefit limit.

For example, if your policy has a $500 annual deductible and you have not yet met it, you will pay the first $500 of the PET scan cost out of pocket. The insurer will then cover the remainder (up to your policy's percentage). If your annual limit is $5,000 and you have already used $4,800 in benefits this year, the insurer will cover only $200 of the PET scan, leaving you responsible for the rest.

Check your policy documents or your online account to see how much of your deductible you have met and how much of your annual limit remains. If the PET scan will exceed your limit, ask your vet whether the scan can wait until the next policy year, or whether a less expensive diagnostic test might provide the same information.

Specialist referral requirements

Some policies cover PET scans only when they are ordered by a board-certified veterinary specialist — such as an oncologist, neurologist, or internal medicine specialist — rather than by a general veterinarian. This requirement exists because insurers want to may support the scan is truly necessary and not ordered as a first-line diagnostic tool.

If your general veterinarian orders a PET scan and your policy requires a specialist referral, the claim will be denied. You will need to get a referral to a specialist, have the specialist order the scan, and then resubmit the claim. This adds time and cost to the process.

Before your general vet orders a PET scan, ask your insurer whether a specialist referral is required. If it is, ask your vet for a referral to an appropriate specialist in your area. Many general vets have standing relationships with specialists and can arrange this quickly.

How to prevent a denial before the scan is scheduled

The best way to avoid a PET scan denial is to contact your insurance company before the scan is ordered, not after. Here is the order of steps: First, your veterinarian determines that a PET scan is medically necessary and discusses it with you. Second, you call your insurer and provide the vet's name, your pet's condition, and the reason for the scan. Third, you ask whether pre-approval is required and request it if it is. Fourth, you ask whether the recommended imaging facility is in-network. Fifth, you confirm the percentage your policy will cover and whether you have met your deductible.

Write down the name of the person you spoke to, the date, and what they told you. If the insurer approves the scan, ask them to send you written confirmation. If they deny it or say it is not covered, you can discuss alternatives with your vet — such as a less expensive imaging test, a second opinion, or waiting to see whether symptoms develop.

This process takes 15 to 30 minutes and can save you hundreds or thousands of dollars in unexpected out-of-pocket costs.

What to do if your claim is already denied

If your PET scan claim has already been denied, you have the right to appeal. Start by requesting the denial letter from your insurer in writing — it should explain the specific reason for the denial. Common reasons are "not medically necessary," "pre-approval not obtained," "out-of-network facility," or "condition excluded."

Once you know the reason, gather evidence to support your appeal. If the denial says the scan was not medically necessary, ask your veterinarian to write a letter explaining why the scan was necessary given your pet's symptoms and medical history. If the denial says pre-approval was not obtained, submit a pre-approval request now and ask the insurer to reconsider. If the denial says the facility was out-of-network, ask whether they will cover it at the in-network rate.

Submit your appeal in writing, include all supporting documents, and keep a copy for your records. Most insurers have a 30 to 60-day window to respond to appeals. If the appeal is denied, you can file a complaint with your state's insurance commissioner, though this process is slow and does not may provide reimbursement.

Frequently Asked Questions

Can I appeal a PET scan denial if my vet says it was medically necessary?

Yes. Request your denial letter, ask your vet to write a letter explaining the medical necessity, and submit both to your insurer as an appeal. Include any test results or imaging that led to the PET scan recommendation. The insurer will review the appeal, though approval is not may provide.

What if my policy does not mention PET scans at all?

Call your insurer and ask whether PET scans are covered under your policy's diagnostic imaging benefit. If they are not specifically listed, ask whether they fall under a broader category such as "advanced imaging" or "specialist diagnostics." Get the answer in writing.

Will my insurer cover a PET scan if my vet orders it without a specialist referral?

It depends on your policy. Some policies do not require a specialist referral; others do. Call your insurer before the scan is ordered and ask whether a specialist referral is required for your specific condition. If it is, ask your vet for a referral.

Can I use an out-of-network facility if there is no in-network PET scan center near me?

You can, but contact your insurer first to ask whether they will cover it and at what percentage. Some insurers will cover out-of-network scans if no in-network facility is available within a certain distance. Get approval in writing before the scan is performed.

How long does it take to get pre-approval for a PET scan?

Most insurers respond to pre-approval requests within 3 to 7 business days. Some respond faster if you call instead of submitting the request by mail. Ask your vet to submit the request as soon as the scan is recommended, and follow up with the insurer if you do not hear back within a week.