Are the scans covered by my insurance?
PPO ("Preferred Provider Organization")
Most PPO insurance companies are reimbursing from the "out-of-network benefits." Depending on your
plan and the insurance company, insurance company's throughout the States are reimbursing anywhere from 50-100%.
Some PPOs require a referral from a physician along with a diagnostic code. A diagnostic code establishes the
reason for the medical necessity of the plan (for instance a family history, cholesterol, diabetes, etc.).
If the patient is subjected to a deductible for going outside of the network, the cost will be applied to the
deductible. If this satisfies the deductible the rest will be reimbursed at the out-of-network benefits.
PPO Insurance Tips
- All insurance companies will require a prescription from your physician with the reasons of medical necessity before they will reimburse.
- You will need to include the patient receipt with the prescription when you are billing your insurance.
- If you are a government employee, your PPO medical insurance may not cover this procedure. Please contact your insurance company prior to your scan.
HMO ("Health Maintenance Organization")
An HMO will generally not reimburse for any part of this procedure.
What kind of scans are available?
MEDICARE
Medicare will generally not reimburse for this scan. You will have to contact your scanning facility to determine
whether they are an enrolled Medicare facility. Unfortunately, a secondary or a supplement to Medicare is also
not a possibility. A secondary and supplemental insurance company will require Medicare to decline the service before
they will consider reimbursing.
POS ("Point of Service")
A Point of Service (POS) plan has a HMO and a PPO built inside of the plan. This plan may reimburse under the
out-of-network PPO benefits. The patient should contact their insurance to be certain.
