Author: Simon Kipersztok, M.D., University of Florida

Osteoporosis Screening and Reimbursement

An issue frequently raised by practitioners and patients is that of reimbursement for BMD studies by common insurance carriers. This is an important issue since the cost of screening, if not covered by the health insurance carrier, can be a deterrent particularly in populations of patients that are retired and live with a limited income. The Health Care Financing Administration (HCFA) through Medicare provides some reimbursement of screening done for patients at risk for osteoporosis as were defined by a consensus panel organized by the National Osteoporosis Foundation and this includes women who are estrogen deficient. Since many health insurance carriers model their reimbursement practices after those followed by Medicare, it is likely that many such carriers may cover the expenses for osteoporosis screening. If that is not the case, practitioners and patients should encourage non covering carriers to reconsider their lack of coverage.

The issue of reimbursement for osteoporosis screening was brought to the political arena when in 1996 the State of Florida legislature passed a bill called "Osteoporosis prevention and education program" which Governor Lawton Chiles enacted into law. The bill mandates all companies involved in the delivery of health care services in the state to provide coverage for the medically necessary diagnosis and treatment of osteoporosis for high-risk individuals which includes postmenopausal women. The bill also mandates the executive branch of the state to establish an educational program which will educate citizens and health care professionals about the evaluation and treatment of patients with osteoporosis (Chapter 96-282, Laws of Florida). Many authorities predict that bills such as this one will, in the long run, prevent fractures and their complications in a substantial number of patients and also translate into savings of increasingly scarce health care dollars.