Contrast-enhanced mammography (CEM) is a newer imaging technique that uses a contrast agent to enhance the visibility of breast tissue, potentially improving the accuracy of breast cancer detection. Many women may be concerned about whether CEM is covered by insurance and how much they will have to pay out of pocket. In this article, we will discuss whether CEM is covered by insurance and what factors can affect insurance coverage.
The coverage of CEM by insurance plans can vary depending on the type of plan, state regulations, and individual insurance policies. However, in many cases, CEM is covered by insurance plans, particularly if a traditional mammogram is also covered. It is important to check with your insurance provider to determine your specific coverage and any out-of-pocket costs that may be associated with the procedure.
In some cases, insurance providers may require prior authorization for CEM. This means that your healthcare provider will need to submit a request to the insurance provider for approval before the procedure can be performed. Prior authorization is typically required for procedures that are considered experimental or that have a high cost.
It is also important to note that if a CEM procedure is performed for diagnostic purposes, such as to evaluate a suspicious lump or abnormality detected on a previous mammogram, it may be covered by insurance. However, if a CEM procedure is performed for screening purposes, it may not be covered by insurance.
If you are concerned about the cost of CEM or any out-of-pocket expenses, it is important to discuss your options with your healthcare provider and insurance provider. In some cases, financial assistance may be available to help cover the cost of the procedure.
In conclusion, the coverage of contrast-enhanced mammography by insurance plans can vary, and it is important to check with your insurance provider to determine your specific coverage and any out-of-pocket costs. Prior authorization may be required for the procedure, and coverage may also depend on whether the procedure is performed for diagnostic or screening purposes. If you have concerns about the cost of CEM, discuss your options with your healthcare provider and insurance provider.