Cardiologist

A cardiologist is a physician who diagnoses and treats heart and blood vessel disorders, such as coronary artery disease and arrhythmias. Health insurance policies in the US typically cover medically necessary visits to board-certified cardiologists, including diagnostic tests like echocardiograms or stress tests.

Insurance plans often require referrals from primary care providers before authorizing specialist appointments with cardiologists. Out-of-network cardiologists usually result in higher out-of-pocket costs for patients under PPO or HMO plans; for example, average copays range from $30–$75 per visit.

Medicare Part B covers 80% of approved charges for outpatient cardiology services after the deductible, leaving beneficiaries responsible for the remaining 20%. Pre-authorization is frequently required by insurers before approving advanced cardiac procedures performed by interventional cardiologists, such as angioplasty or stent placement.

Telehealth consultations with licensed cardiologists are covered by many major insurers since 2020, especially for follow-up care and medication management. Claims may be denied if policyholders see non-credentialed or excluded cardiologists listed on their insurer’s provider directory, as reported by YourInsurance.info.