Osteoporosis Screening: When Will Insurance Cover DXA?
Most physicians agree that Dual Energy X-ray Absorptiometry, often called DEXA or DXA, is the "gold standard" when it comes to determining your bone density. If you have received a worrisome result from another type of exam, such as a heel or fingertip scan, or have another reason to be concerned about your bone health, you may want to talk to your doctor about undergoing a DXA.
However, you might be concerned about the cost of the procedure, which can run $200 or even higher. Unfortunately, a DXA is not always covered by insurance - it depends on your specific plan and level of coverage. In fact, in recent years some doctors have experienced an increasing frequency of denial of claims for the test.
If you are a woman over 65, you have nothing to worry about in this regard. Medicare will cover one DXA scan every other year; sometimes more frequently if the patient is receiving treatment for bone loss. In addition, the vast majority of insurance plans will cover a DXA screening for any postmenopausal woman, including younger women who have received a hysterectomy.
However, in the case of men and premenopausal women, the physician must generally provide the insurance carrier additional information as to why the test is being requested - particularly if you have been so fortunate as not to have a fracture yet. For this reason, it is especially important to make sure you provide your doctor with your complete medical and family history (which, of course, is always a good policy). An extended period of taking medications known to contribute to a decline in bone density - such as corticosteroids and certain types of chemotherapy - is also a valid reason, so be sure to discuss your long-term drug history with your doctor in addition to listing any medicines you take presently.
For a DXA to be authorized, your doctor may able to cite any risk factors you have for osteoporosis, such as heavy smoking, a family history of the disease, or deficient levels of calcium or Vitamin D. In addition, if your height has decreased in recent years, be aware that loss of stature is a serious warning sign of osteoporosis that the doctor may cite to justify the procedure. And simply being a slender, Caucasian female (the demographic most likely to develop osteoporosis) may be enough to convince your carrier you need the scan.
As a last resort, your doctor could cite a troubling result received from a finger or heel scan as a rationale for the DXA. While some insurance companies may consider that claim, don't count on it. Since the spine and hip are considered the most critical parts of the body for bone density, the information presented on other areas may be deemed by the carrier to be inconsequential to the risk of developing osteoporosis.