Insurance Issues
Our center is committed to provide the best available
proven methods to detect life's most important illnesses early. Many of
our patients self-purchase our procedures without insurance involvement,
just as they would spend money on yearly preventive assessment for their
automobiles. Many individuals will seek insurance coverage for our
procedures —in some cases they are covered.
We recognize however that many managed care
organizations do not share our interests in prevention and are largely
paying only for symptomatic diseases. Frankly, paying for a heart scan
is not often financially attractive to an insurance company or HMO
unless you have risk factors and your doctor is attempting to make a
decision about lifelong medications anyway. Nationwide, after getting a
heart scan, thousands of citizens will be encouraged to be on
medications (which will be covered) to prevent heart attacks, etc that
may not occur for many years —typically after one has changed insurance
policies.
If you have risk factors for heart disease, ask your
doctor to ask your managed care company for "individual consideration"
for coverage in order for him/her to make a precise determination of
your need for therapy.
If your doctor is planning on using this test to
make a diagnostic decision or to guide therapy, please print out
the "Request for
Individual Consideration for Coverage" and give it to your doctor.
Your doctor will likely be of more help if he/she does not have to
create a time-consuming request for coverage for you. This form will
make it easier for your doctor and improve the chances for coverage. You
can then submit it to your carrier for consideration in your case. In
general, if you have no risk factors and are using the test as a pure
screen, it is not worth requesting coverage.
The heart scan is an extensively proven procedure
available at leading heart centers worldwide. There are many book
chapters and articles published proving its accuracy and value. If your
company explains to you that the electron beam CT of your heart is
"experimental or investigational", you may want to re-consider your
relationship with that organization. We believe insurance companies
should never mischaracterize a procedure to defend its policies of
non-coverage. Such statements will surely result in forfeiting the only
opportunity for thousands to know they are at high risk and need
treatment.
Front Range Preventive Imaging works with
various insurance companies concerning coverage of its procedures. In
some cases, preventive heart scans are covered as a screening test. More
commonly, the procedure will be covered when a doctor refers to make a
decision about therapy or a diagnosis.
The procedure code for Electron Beam
Tomography of the heart for coronary calcification imaging is 0144T
(Calcium Scoring). It is always helpful to contact your carrier to find
out under which circumstances the EBT heart scan is covered, if at all.
If our center has a clear contract with your company (and you meet their
guidelines), we will bill the company for the test. Otherwise, we expect
payment at time of service. A Health Insurance Claim Form will not be
provided.
Remember, our center shares a goal with
our patients to prevent heart attacks which may occur many years after
the 2-3 year average period of time a person stays with an HMO. More
enlightened managed care companies develop guidelines so that coverage
is determined based upon risk factors, symptoms or in concert with the
plans of a referring physician.
