Christy Carlson Romano’s PET Scan Was Denied — What to Do When Insurance Says No to a Doctor-Ordered Test
In February 2026, actress Christy Carlson Romano, best known for playing Ren Stevens on the Disney Channel series Even Stevens and for voicing the title character in the animated series Kim Possible, told her Instagram followers something a lot of patients quietly live through. Her cancer screening came back “not negative”. When her doctor ordered a PET scan, she struggled to get her insurance to cover it.
Her experience isn’t unusual. A 2026 analysis from BillKarma, which reviewed claims data across more than 4,800 hospitals, found that 34% of PET scan prior authorization requests are initially denied by commercial insurers, one of the highest denial rates of any imaging test.
Why Pet Scans Get Denied So Often
PET scans average $3,000 to $6,000 at hospital outpatient departments, per BillKarma’s 2026 pricing data. The same scan often runs $1,500 to $2,800 at a freestanding imaging center. Insurers use that price tag to justify a tight prior authorization process.
Common reasons a scan gets denied include no prior authorization on file, the facility being out of network or the insurer deciding the scan doesn’t meet its medical necessity criteria. A CPT billing code mismatch between what was authorized and what the facility billed is also a frequent culprit. In some cases, a single-digit difference between those two codes is enough to trigger a denial.
What Changed for Patients Who Need Prior Authorizations in 2026
A federal CMS rule (CMS-0057-F) took effect January 1, 2026, requiring insurers to respond to standard prior authorization requests within 7 calendar days and urgent requests within 72 hours, down from 14 days previously, per HealthBillCentral’s 2026 prior authorization guide.
Patients now have 180 days from the date of a denial notice to file an internal appeal, per HealthCare.gov. Starting March 31, 2026, Medicare Advantage, Medicaid and ACA marketplace insurers are also required to publicly post their prior authorization approval rates, denial rates and appeal outcomes.
What to Do Step by Step if a Test Gets Denied
Read the denial letter first. The reason code tells you what you’re dealing with: CO-197 means lack of prior authorization, CO-50 means the insurer decided the test wasn’t medically necessary. The reason determines your next move.
If the issue is a coding problem, ask your doctor’s office to confirm the correct CPT code was submitted. A billing error can sometimes be corrected and resubmitted without a formal appeal at all.
Next, request a peer-to-peer review, where your ordering physician speaks directly with the insurer’s medical director. Muni Health’s 2026 guide reports more than 50% of denials are overturned at this stage alone.
If that doesn’t resolve it, file a formal internal appeal with your denial letter, physician notes, prior test results and a letter of medical necessity. HealthCare.gov confirms internal appeals must be decided within 30 days for services not yet received.
Next Steps if You’re Really Stuck
Still denied? You’re entitled to request an independent external review. A March 2026 KFF analysis found that nearly half of all external review decisions overturn the initial denial. If timelines are violated or the process stalls, contact your state Department of Insurance directly.
The appeal process overturns denials at meaningful rates when patients push back. Knowing the codes, the deadlines and the right sequence of steps is what moves a denial toward coverage.
For situation-specific guidance, consult your plan documents, your physician or your state insurance commissioner.
This article was created by content specialists using various tools, including AI.
