Is Prostate Artery Embolization covered by insurance?
Private insurance coverage for PAE
Most private insurance plans in Texas cover prostate artery embolization (PAE). Private insurance plans vary widely, even within the same insurance provider. Some insurance plans have detailed coverage guidelines regarding prostate artery embolization, while others do not. Some plans also require prior authorization before performing the procedure. The good news is that, at this point, most of the private plans have been approving prostate artery on for patient care.
Medicare of Texas insurance coverage for PAE
Medicare of Texas covers prostate artery embolization for the treatment of enlarged prostate symptoms. While private insurance has been slowly coming around to prostate artery embolization, Medicare has been approving it for several years now. Medicare will cover 80% of your PAE costs. The procedure is outpatient and performed in an office setting, so that it will be covered by Medicare Part B. The other 20% will fall under the supplemental Medicare plan, also known as Medigap.
Medicare Replacement or Medicare Advantage Plans
The private insurer Medicare replacement plans of Texas cover prostate artery embolization. In general, the Medicare Advantage plans cover all of Medicare Parts A and B, with a few exceptions regarding clinical trials and recently approved therapy. They also cover some services in addition to what Medicare covers.
What happens if prostate artery embolization is denied by insurance?
If your insurance provider does not cover prostate artery embolization for enlarged prostate symptoms, we can appeal the decision and write a letter. Additionally, it is very helpful for patients to call and request coverage along with the appeal. Recently, the American Urology Association included prostate artery embolization for the treatment of an enlarged prostate (see guidelines here).
At Summit Interventional Radiology, we have helped hundreds of men through the process of getting their enlarged prostate symptoms covered by their insurance plan. To schedule an appointment with our Austin interventional radiologist, please don’t hesitate to contact us.