Private payer coverage policies are critically important in the use of medical services. Through them, payers define what they will pay for and the specific conditions, indications, and circumstances that are necessary for payment. Their coverage policies also often make clear what they will not pay for.
Coverage policies change over time, particularly as new evidence becomes available and as new medical technologies are developed. Sometimes these adjustments reverse previous policies; sometimes they merely footnote new studies or other information.
This page highlights key coverage policies, but it is important to understand that they are just highlights. Payers maintain thousands of policies.
Company: Aetna
Policy: Magnetic Resonance Spectroscopy (MRS)
Date: April 2017
Company: Aetna
Policy: CT Colonography
Date: March 2017
Company: Aetna
Policy: Cardiac CT, Coronary CT Angiography, and Calcium Scoring
Date: January 2017
Company: Blue Shield of California
Policy: Coronary CTA
Date: February 2017
Company: Blue Cross Blue Shield of Illinois
Policy: Digital Breast Tomosynthesis
Date: August 2015
Company: Blue Cross Blue Shield of Illinois
Policy: CT Colonography
Date: January 2016
Company: Health Care Services Corporation (HCSC)
Policy: Endobronchial Ultrasound for Diagnosis and Staging of Lung Cancer
Date: January 2016
Company: Health Care Services Corporation (HCSC)
Policy: Radiofrequency Ablation (RFA) of Primary or Metastatic Liver Tumors
Date: May 2016
Company: Humana
Policy: CT Colonography
Date: February 2017
Company: United Healthcare
Policy: Digital Breast Tomosynthesis
Date: April 2017
