Does insurance cover prostate artery embolization?
The vast majority of the time, insurance plans will pay for prostate artery embolization (PAE). Our Austin prostate specialists accept a broad range of insurance options, many of which provide insurance coverage for prostate artery embolization.
In America, there are a handful of broad categories of health insurances, hundreds of companies offering insurance plans, and numerous options from each company. While many of them do provide insurance coverage for prostate artery embolization, listing the payment policies of each plan here isn’t realistic – and even if we did, the coverage of procedures such as PAE often does not match the medical policy set forth by the insurance company.
This brief article provides some rules of thumb and the framework for working through the insurance companies to verify insurance coverage for PAE or get prostate artery embolization covered by your plan.
Types of insurance coverage for prostate artery embolization
Public or government-sponsored health insurance covers about one-third of the population. These include Medicare, Medicaid, Tricare and several others. These follow national and local coverage guidelines for insurance coverage for prostate artery embolization. Luckily, in Texas, PAE is an approved treatment for symptoms of an enlarged prostate.
Medicare is the largest public insurer, and it covers 80% of the cost of outpatient procedures. If combined with Medigap supplemental insurance that follows Medicare, the remaining 20% of the procedure cost will be shared between a patient and the insurance plan, which usually covers the majority.
Another type of Medicare is an Advantage Plan.
These plans differ from traditional Medicare in two major ways. First, they are offered and managed by private insurers, yet funded by the government. Therefore, these plans can require prior authorizations, referrals to see specialists (like an interventional radiologist who performs PAE), and can exclude providers who are out of network. Second, while these plans are supposed to mirror Medicare, they occasionally use their own medical policy guidelines where Medicare is not explicit, and will end up denying procedures that traditional Medicare covers – including PAE. If this occurs, our Austin prostate specialists will fight for your insurance coverage for prostate artery embolization.
Private insurance companies cover around two-thirds of the population.
This includes companies such as United Healthcare, Cigna, Humana and Blue Cross Blue Shield. Each company has its own medical policy, which is specific to each state. These plans will either provide insurance coverage for PAE based on their policy, or require prior authorization, which our office will apply for. Despite PAE often being listed as “experimental,” it is usually approved. This is not surprising, as PAE is listed as an appropriate option for treating enlarged prostates by the American Urological Society and the Society of Interventional Radiology consensus guidelines.
Contact us for help with insurance coverage for PAE
If your plan denies PAE for treatment of your enlarged prostate symptoms, our Austin prostate specialists will file an appeal on your behalf to plead your case. If you need more information about your insurance coverage for PAE, call your insurance company to ask about your benefits, or contact our billing team.