Unless you live in Texas, you will have to pay out of pocket for a . Insurers and Medicare won't pay a dime for this simple test that progressive preventive cardiologists and primary care docs rely on to better determine who is at risk for heart attacks and sudden death.
But, as we enter 2020, perhaps this failure to cover our best tool to detect subclinical atherosclerosis can be reversed. To my surprise, earlier this week, a patient of mine revealed to me that UnitedHealthcare had reimbursed him for the CAC scan he had done earlier in 2019.
It wasn't easy or straightforward, but his process may work for others. I asked him to email me the letter he sent that resulted in coverage, which I have copied below:
As discussed in your office today, I was able to get my insurance company (UnitedHealthcare) to reimburse me from the Cardiac Calcium Scoring costs of $125 after filing an appeal through my former employer. Below, as requested, is the simple write up I provided to them.
I visited a cardiologist (Dr. Anthony Pearson) in May 2019 regarding heart palpitations I had with increasing frequency. He performed a variety of diagnostic tests (blood work, Holter monitor, echo stress test), which were all covered by UHC. Because these tests did not show any issues, he suggested I have a Cardiac Calcium Scoring Test, which I completed on May 24, 2019. The test showed that I had serious coronary artery disease (score of over 800), which caused the cardiologist to prescribe a daily baby aspirin and a statin medicine (also covered by UHC). While I was told that the Cardiac Calcium Scoring Test cost is not covered by insurance, this is the one and only test that indicated I was at a severe risk for a coronary artery event (significant or total blockage) and, per the cardiologist, may have saved my life or perhaps avoided an unexpected significant cost (e.g. bypass surgery) by catching the issue early.
To recap, St. Luke's Hospital did not submit a claim for the $125 cost of the Cardiac Calcium Scoring Test because they said no insurance company pays for this test. This test was ordered by my cardiologist, Dr. Anthony Pearson, and was performed at St. Luke's Hospital in St. Louis. I am requesting reimbursement for the cost of this test for the reasons stated above.
The UnitedHealthcare explanation of benefits contained this claims summary:
It would appear the mighty wall that insurers and the Centers for Medicare and Medicaid Services have put up against paying for CAC scans is crumbling and can be breached.
I highly recommend all patients who have gotten an appropriately-ordered CAC scan go through this process with their insurers to attempt to obtain reimbursement.
, is a private practice noninvasive cardiologist and medical director of echocardiography at St. Luke's Hospital in St. Louis. He blogs on nutrition, cardiac testing, quackery, and other things worthy of skepticism at , where a version of this post first appeared.