With life-threatening diseases like Cancer, Cardiovascular Diseases (CVD), Neurological Disorders, COPD, Trauma & infections growing rampantly in the last few years, it has become imperative to cover ourselves and our loved ones under the blanket of Insurance. But do you know where most people fail when choosing insurance coverage? It’s the health insurance for OPD! We can’t stress enough the fact that health insurance for OPD diagnostic tests, like CT scans, X-rays, MRIs, EEGs, etc., can just be the fine line between having to pay thousands out of your pocket and paying nothing at all!
In today’s world with rampant diseases, diagnostic tests are performed to get to the prognosis faster, hence it becomes all the more important to get yourself and your loved ones covered by health insurance. If you have health insurance that covers these diagnostic tests as part of the package you not only provide financial security during medical uncertainties but also release you from the disappointment of returning from your insurer empty-handed.
Though we do take steps to ensure that we are covered during such uncertain times, we miss the fine print when it comes to “What’s covered in the Insurance?”
A diagnostic test like a CT scan has become a norm among Doctors to arrive at the root cause of a problem. Doctors consider CT scans to be benchmark diagnostic tools to assess your health and arrive at a prognosis.
Now although these tests are unavoidable, you can save yourself from paying hefty bills.
When it comes to CT scans - a diagnostic test, the most asked question is, “How much does a CT scan cost without insurance?” Though there is not a straightforward answer to it as it depends on a number of factors like the type of CT scan, where you are taking the scan, and the technology used, (We have covered this in detail below), but to give you an approximate idea it costs anywhere between the range of Rs. 3,000/- to Rs. 8,000 for ONE CT Scan. That’s a Big hole in the pocket if it's not considered in your Insurance. If there are multiple CT scans to be done then you need to be ready to spend an enormous amount of money!
So, Are CT scans covered by Insurance?
Well, It’s important to understand some basics when it comes to insurance and it is important to note that not every health Insurance company works by the same rules and there are terms and conditions attached to each insurance.
Here, We put before you the basics that you need to get right to understand what to look for in health insurance, & answers to the question: Does insurance cover a CT scan?
What Is A CT Scan?
Computed Tomography, popularly known as CT scan is a 20-minute pain-free means of diagnosis, that uses a double combination of X-rays and computer technology. It produces high-resolution cross-sectional images of the bones, muscles, organs, and blood vessels inside the body and helps the healthcare professional to arrive at a prognosis. A CT scan produces multiple images per second which get compiled together to generate 3D images for analysis & reports.
Importance of CT Scans
CT scans are used in the field of medicine because of the innumerable benefits they offer:
Diagnosis of Critical Illnesses:
CT scans are immensely helpful in diagnosing a range of medical conditions which includes bone and muscle injuries, infections, tumors, vascular diseases, and organ abnormalities, helping doctors identify and understand the nature of the condition.
Early Detection:
CT scans play a key role in the early-stage detection of critical illnesses like lung cancer, hence improving the life span of the patient by early intervention.
Surgical Planning:
Complex surgeries become easier to handle using detailed CT scan images of the body's internal structures
Monitoring Treatment: CT scans have proved to be life-savers for cancer therapy whereby comparing CT images taken at different points in time helps doctors to assess how well a treatment is working.
Emergency Medicine: CT scans are especially helpful in decision-making during the assessment of traumatic injuries, internal bleeding, or other life-threatening conditions.
Non-Invasive: The best part is that CT scans are non-invasive procedures hence reducing the risk to the patient and facilitating a quicker recovery.
Factors Affecting The CT Scan Cost & Insurance Coverage
Before we delve into the details of insurance, it is of utmost importance to note that CT scan is a generic term and in reality, a doctor might recommend different types of CT scans based on your condition. The following factors will help you understand what you should be looking for in your insurance and is a fine print that doesn’t cover the following:
Scan Type:
There are various CT scans like head CT scan, Full body CT scan, Spine CT scan, sinus CT scan, Abdominal CT scan, etc. The cost of a full-body scan is higher than a sinus CT scan.
Pre/Post CT Scan services:
Whenever we talk about a disease it doesn’t start and end with a CT scan. There are additional expenses like follow-up visits, or second opinions or consultations that add to the overall cost of a CT scan. It’s good to check with your insurance provider if they cover these in their Insurance.
CT scan Technology:
CT scan technology gets updated every year and hence can affect the overall cost. Current CT scans use technology that is more advanced and hence expensive as compared to the other scans.
Number of scans:
The number of scans required for the diagnosis can also affect the overall cost of the CT scan.
CT Scan Done in Hospitals versis diagnostic centres:
Though there are Special diagnostic centers to get a CT scan done, some Doctors/health care professionals insist on having CT scans done at their hospitals for easier communication and logistics. Hence the cost of a CT scan varies with respect to where it is being done.
Inpatient/Outpatient Facility
The main criteria that change the cost is whether you are an Inpatient or Outpatient. Inpatient CT scans are costlier as running inpatient facilities requires greater infrastructure, staff, and expenses, as compared to outpatient facilities.
Insurance
Now we come to the main part and that is Insurance! Usually, most healthcare insurance cover covers CT scans but there are other factors that play a crucial role in deciding if you will get the benefit of insurance for your CT Scan as explained below.
Does Insurance Cover a CT scan?
Though you would look for a straight Yes and No as an answer to “Are CT Scans Covered By Insurance?” However, the fact remains that insurance companies cover CT scan costs when specific criteria are met. You have to pay attention to the Health Insurance Coverage Terms where the Insurance Companies want you to answer these questions:
Is the CT scan Necessary?
2. Have you Provided details of Pre-existing Diseases?
Have you understood what comes under “Medical necessity”?
What Type of insurance plan do you have?
Are the Hospitals or Diagnostic centers covered under your Insurance?
Is Diagnostic Test Facility Covered in the Health Insurance?
Will your insurance cover your full Bills?
5. Are you an Inpatient or Outpatient?
1. Is the CT scan Necessary?
Nobody wants to spend money on CT scans, but insurance companies are very specific about the necessity of the CT scan. CT scans help diagnose a wide range of diseases but the most important points that you must ensure from your end are
You should have a valid prescription from a practicing Doctor that states that you need a CT scan for your condition. You may require this when you are filing for a claim. Without a prescription, the insurance company may reject the claim or refuse to cover the expenses.
Most insurance companies have a deductible (a financial limit that you have to cross before your health insurance starts.) or a time period after purchasing an insurance plan after which the insurance coverage starts.
CT scans help in evaluating/diagnosing/monitoring diseases and are covered by insurance if they are considered necessary for the diagnosis or management of a disease.
2. Have you Provided details of Pre-existing Diseases?
It is absolutely necessary that you give clear details about your health condition or pre-existing diseases prior to enrolling for health insurance. If you fill out incomplete details, you might have to shell money from your pocket because of a lack of transparency.
Some Insurance companies need prior intimation before you undergo medical procedures or hospitalization. It is a good practice to inform the insurance companies in advance to ensure coverage.
3. Have you understood what comes under “Medical necessity”?
At the end of the Day, the power lies with the Insurance company and it is essential to have a proper look at their terms and conditions.
Insurance companies have the right to decide if the CT scan is medically necessary, appropriate, and essential.
4. What Type of insurance plan do you have?
The type of Insurance plan has many variables and there are three aspects that you MUST look into to get “Yes” as an answer to the query “Are your CT Scans Covered By Insurance?
Are the Hospitals or Diagnostic centers covered under your Insurance?
Before you go for a CT scan ensure that the hospital or CT scan company/diagnostic center is part of your Insurer's network.
Some hospitals or diagnostic centres don’t approve the scan at all, while for others you may have to pay the bills and produce them to your insurer to get it reimbursed.
Is Diagnostic Test Facility Covered in the Health Insurance?
Each Insurance covers certain fixed components like 24-hour hospital stay and procedure charges, while health insurance has an add-on feature where pre and post-hospitalization procedure charges are covered.
There are some insurances where you can add Diagnostic test facilities with your regular health insurance.
Will your insurance cover your full Bills?
Another very crucial factor that answers, is whether a CT scan is covered by insurance. is the percentage of overall bills that the insurance will cover.
Not every insurance covers 100% of your bills, and it is usual practice for the insurance company to opt for ct scan copay wherein the insurer pays 80% of the bills and the remaining 20% is paid by you.
Hence, it is recommended to get this part clarified so that your CT scan charges are covered.
5. Are you an Inpatient or Outpatient?
An Inpatient system works differently as compared to an outpatient. 90% of the health insurance covers all the expenses if you are hospitalized for 24 hours and covers CT scan charges if done during the hospitalization period.
There are other specific health Insurances that cover outpatient diagnostic tests without hospitalization. Be sure to ask about these before opting for insurance.
In conclusion, in the current scenario where life-threatening diseases are on the rise, being well-informed is not a choice but a necessity!
Being aware of your health insurance is not only financial security but also provides peace of mind during challenging times. The key to a happy, healthy life in this age lies in asking the right questions and making well-informed decisions. So, How much is a CT scan with insurance? Well if you make informed decisions and consider the factor stated above you have to pay Nil and that shows that your health is in the right hands!