Larry,
Sorry to hear about the situation with your wife. I know there is nothing in the NCCN guidelines with regard to IMRT and it is always tough when trying to deal with insurance companies over anything.
PET scans are fairly common and I had one after my first recurrence of bladder cancer because the idea is to see if it has spread. So...if the PET scan gets ordered in order to rule out the spread of the bladder cancer, it seems like it should be covered. I was on BCBS when I had my PET scan and it was never an issue. Didn't even require preapproval unless it was done behind the scenes without my knowing about it.
I hadn't even heard of IMRT (or may have in passing) but it doesn't look like it has been used much for bladder cancer from any sites on IMRT that I found. One site said: The areas most commonly treated with IMRT are: prostate, spine, lung, breast, kidney, pancreas, liver, larynx, tongue and sinus. The brain is treated with IMRT when one-session radiosurgery is not appropriate or unavailable.
Also, most sites I read said that insurance often does not cover it. No idea how much it costs. Best of luck with getting them to reconsider.
Bladder cancer has one of the highest recurrence rates of all cancers. That works against you when trying to argue for a treatment that is only going to address this specific tumor because if it is muscle invasive the risk of metastasis is high. The recurrence rate is high enough that insurance may say, even if you get the tumor, it is just going to come back and if you can't remove the bladder it is going to be radiation after radiation until it spreads. Not letting her get the PET scan doesn't seem to make sense unless the radiologist is asking for only a pelvic CT/PET. If they as for a full body PET scan, that is looking for any remote spread (metastasis).
What stage did they say the cancer is? The first level of muscle invasive is T2. T4 is that it has already gone all the way through the muscle to outside of the bladder.
Sorry I can't offer more information. I've been working (to use a polite term) with my insurance company for three months already on trying to figure out why they decided after 15 years that my 60mg of simvastatin is now no longer a safe dose. So far, I am not winning that fight even though I gave them the FDA study that says even 80mg is safe if one has been on it for over a year without muscle damage. My doctor has sent appeals and letters of medical necessity. The weird thing about my case is my deductible isn't even paid so I have to pay for all of it myself anyway.
Mike