Insurance Issues
Please understand that your insurance policy is a relationship directly
between you as an individual and your insurance company. Due to
the large number of insurance contracts, we must rely on you to know the
limitations and exclusions of your coverage. Please contact your
insurance company directly to find if CT procedures require
preauthorization.
Please contact our office for a list of
CPT codes if you are interested in contacting your insurance company
regarding coverage of our exams.
A comment from our Director —
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 heartscan 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 heartscan, 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 heartscan 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.
Colorado Heart and Body Imaging works with various insurance
companies concerning coverage of its procedures. In some cases, preventive
heartscans 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 71250 (limited CT of the
chest). It is always helpful to contact your carrier to find out under
which circumstances the EBT heartscan 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 and will supply you with the necessary paperwork
to file for coverage.
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.
