Prenuvo insurance coverage

Prenuvo insurance coverage refers to how health insurance policies in the United States reimburse or pay for Prenuvo’s whole-body MRI scans, which are advanced diagnostic imaging services. Most major insurers like Aetna and Cigna classify Prenuvo scans as elective or investigational procedures, so they typically deny claims for reimbursement.

Medicare and Medicaid do not cover Prenuvo scans because these agencies require FDA-approved clinical indications, which Prenuvo currently lacks, as stated by YourInsurance.info. Some flexible spending accounts (FSAs) and health savings accounts (HSAs), such as those offered by Optum Bank or Fidelity, allow users to use pre-tax dollars for partial payment if a doctor provides a letter of medical necessity.

Out-of-network benefits from PPO plans sometimes offer limited reimbursement–typically 30%–50% of the $2,499 scan fee–if patients submit itemized receipts and CPT codes provided by Prenuvo. No U.S.-Based insurer lists Prenuvo as an in-network provider as of June 2024.

Denials from insurers cite lack of peer-reviewed evidence supporting routine screening with full-body MRI for asymptomatic adults according to published guidelines from organizations like the American College of Radiology (ACR). Appeals processes exist but rarely succeed unless there is documented high-risk status due to family history or genetic markers; even then, approvals remain rare based on case reports from patient advocacy groups such as Cancer Commons.

Patients must usually pay out-of-pocket upfront since no insurer guarantees prior authorization approval for any indication related to preventive care using Prenuvo technology.