Genicular Artery Embolization vs Cortisone: aetna Coverage
Side-by-side comparison of aetna coverage for genicular artery embolization and cortisone, including coverage status, prior authorization requirements, and estimated costs.
Coverage Comparison
How aetna covers each treatment option side by side.
| Factor | Genicular Artery Embolization | Cortisone |
|---|---|---|
| Coverage Status | Not Covered | Covered |
| Prior Authorization | Not Required | Not Required |
| Estimated Cost | Varies by plan | $100-$300 per injection (with insurance copay typically $20-$50) |
| Evidence Level | strong | |
| Requirements | None listed | 1 requirements |
Which Is Better Covered by aetna?
Cortisone has better coverage under aetna. It is typically covered while Genicular Artery Embolization is not.
Overall Comparison Verdict
Both genicular artery embolization and cortisone have roles in joint pain management. The best choice depends on your specific condition severity, insurance coverage, and treatment goals. Discuss both
See full comparisonCoverage Details
Genicular Artery Embolization
Cortisone
Covered without prior authorization
Prior Authorization Requirements
Genicular Artery Embolization
No specific requirements listed
Cortisone
- Medical necessity
Cost Comparison Under aetna
Genicular Artery Embolization
Cortisone
Costs are estimates and may vary by specific plan, location, and provider. Contact aetna directly to verify your benefits.
Appeal Tips
If coverage is denied for either treatment, here are tips for appealing with aetna:
- File grievance within 60 days
- Include all supporting medical records
- Request peer-to-peer with Aetna medical director
- Consider state insurance commissioner if appeal fails
Steps to Get Covered by aetna
Follow this process to get your treatment approved and minimize out-of-pocket costs.
Verify Your Benefits
Call aetna or log into your member portal to confirm your specific plan covers the treatment you're considering. Ask about deductibles, copays, and any limitations.
Get a Referral (If Required)
Some aetna plans require a referral from your primary care doctor to see a specialist. Check your plan type (HMO plans usually require referrals, PPO plans often don't).
Submit Prior Authorization
If prior authorization is required, your doctor's office will submit the request with clinical documentation including your diagnosis, imaging results, and records of previous treatments tried.
Wait for Approval
aetna typically processes prior authorization requests within 5-15 business days. Urgent requests may be expedited. Your doctor's office can follow up on the status.
Schedule Your Treatment
Once approved, schedule your treatment with an in-network provider to minimize out-of-pocket costs. Keep your approval reference number for your records.
Appeal If Denied
If denied, request the denial in writing and work with your doctor to submit an appeal with additional supporting documentation. Many denials are overturned on appeal.
Frequently Asked Questions
Does aetna cover Genicular Artery Embolization?
Genicular Artery Embolization is not typically covered by aetna. You may need to pay the full cost out of pocket (Varies by plan) or explore appeal options. Ask your doctor to submit a letter of medical necessity if they believe this treatment is appropriate for you.
Does aetna cover Cortisone?
Yes, aetna typically covers Cortisone. Prior authorization is generally not required. The estimated out-of-pocket cost is $100-$300 per injection (with insurance copay typically $20-$50). Verify your specific benefits with aetna before scheduling treatment.
Which has lower out-of-pocket costs with aetna: Genicular Artery Embolization or Cortisone?
With aetna, the estimated cost for Genicular Artery Embolization is Varies by plan and for Cortisone is $100-$300 per injection (with insurance copay typically $20-$50). Since only Cortisone is covered, it will likely have lower out-of-pocket costs. Always verify costs with your insurance before scheduling.
Do I need prior authorization for Genicular Artery Embolization or Cortisone with aetna?
Neither Genicular Artery Embolization nor Cortisone typically requires prior authorization with aetna. However, your provider should still verify eligibility before scheduling treatment.
What if aetna denies coverage for my treatment?
If aetna denies coverage, you have the right to appeal. First, ask for the denial in writing with the specific reason. Then work with your doctor to submit an appeal with supporting clinical documentation, imaging results, and records of failed conservative treatments. Many initially denied claims are approved on appeal. You can also contact your state insurance commissioner if you believe the denial is unfair.
Quick Links
Verify Your Coverage
Coverage can vary by specific plan. Contact aetna directly to verify your benefits for both genicular artery embolization and cortisone.
Genicular Artery Embolization vs Cortisone with Other Insurance
Interested in This Treatment?
You've learned about Genicular Artery Embolization vs Cortisone coverage with aetna. Here's how to move forward:
Take Assessment
See if you're a candidate with our quick assessment
Check Coverage
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