Medical Billing Forum
Billing => Billing => : Asheldon13 March 11, 2013, 12:26:50 PM
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Good Morning All:
Can anyone please give me a clear explanation of why most commercial
insurances won't pay for and EKG when done with the prevenetative visit?
Thanks a bunch.
Anna
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As my insurance company pointed out, they [Chest XRay and EKG] don’t fall into the category of routine preventive services as defined by the U.S. Preventive Services Task Force, the government agency that decides exactly what preventive care insurance companies should be paying for.
Release Date: July 2012: The USPSTF recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events.
From here:
http://www.moneytalksnews.com/2011/10/20/health-care-reform-free-preventive-care-not-exactly/
http://www.uspreventiveservicestaskforce.org/uspstf/uspsacad.htm
Additionally, an EKG is a diagnostic test. Preventive visits generally do not include diagnostic tests.
You might read through this exchange for some additional insight.
http://www.aapc.com/memberarea/forums/showthread.php?t=59812
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Certain plans will include services outside the Standard .. for example, My union plan will cover an EKG as preventative or even as part of a physical (for any age) Same goes for OBGYN services as they changed those standards back in 2009.
You should verify benefits for these services because again, these can be services covered by some plans.
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Thanks everyone. I really appreciate your help.
Anna