The easiest way is to let our office handle it – we will contact your insurance company to verify coverage and obtain any necessary pre-authorization. Typically, once your dermatologist recommends IG-SRT, our billing/insurance coordinator will reach out to your insurer with the appropriate procedure codes and diagnosis. They will confirm: – That IG-SRT (superficial radiation therapy with ultrasound guidance) is a covered benefit under your plan. – If a referral or prior authorization is needed. – What your cost-sharing might be (deductible status, co-insurance percentage, etc.).
We then communicate that information to you.
If you want to be proactive, you can also call the customer service number on your insurance card. You’d ask something like: “Is radiation therapy for skin cancer covered on my plan? Specifically, superficial or image-guided superficial radiation (CPT code such-and-such, if you have it – our office can give you the code) for basal/squamous cell carcinoma.” Most reps can tell you it’s covered subject to usual cost-sharing. They can also tell you if you need a referral or if you must use certain network providers. Central Oregon Dermatology is likely in-network with major plans, but you can double-check your plan’s provider directory or ask.
Additionally, insurance plans often have online portals where you can search covered treatments. But since IG-SRT is just a form of radiation therapy, if your plan covers radiation for cancer (nearly all do), it covers IG-SRT. Some patients feel reassured hearing it directly from the insurer though.
If you’re on an HMO or Medicare Advantage, ensure you’ve got the needed referral from your primary doctor, if required. Again, our staff will help coordinate that if necessary.
You might also inquire with insurance about out-of-pocket estimates. They can sometimes calculate how much of your deductible is left and what co-insurance would apply.
When we submit for pre-auth, we often get a response like “Approved” and any limitations (for example, approved for X number of fractions). We then proceed, and billing goes through insurance.
So in short, to find out coverage: use our office’s verification process or contact your insurer directly. In almost all cases it is covered, but it’s good to confirm details like in-network status and cost responsibilities. We’re here to assist – navigating insurance can be confusing, and we do it routinely.
