Why are Lung Cancer Screenings Not Being Covered By Insurance?

Lung cancer screening guidelines were revised earlier this year. The U.S. Preventive Services Task Force—a body of experts that make preventive health care recommendations—now recommends that adults in the 50 to 80 age group who smoke or have smoked 20 cigarette packs or more each year in the last 15 years, should get an annual lung cancer screen using low-dose computed tomography (LDCT). The earlier age range for lung cancer screening was 55-80 years. However, concerns have been raised by physician experts and some foundations regarding restricted access to LDCT.

Is Lung Cancer a Serious Threat?

The second most common cancer in the U.S. (when you consider both men and women together), and the leading cause of cancer-related deaths, the American Cancer Society has projected that in 2021:

  • There will be 235,760 new cases of lung cancer
  • 131, 880 individuals will die from lung cancer

Lung cancer is more commonly diagnosed in the older population (over 65 years), and the average age at diagnosis is 70. Smoking is the biggest risk factor for developing lung cancer, but non-smokers can also develop the disease.

A person’s chance of survival is much better when lung cancer is diagnosed early (localized). Early diagnosis requires timely screening, particularly in those individuals who do not show symptoms. Some of the common symptoms include:

  • A lingering cough
  • Blood or rust-colored spit/phlegm
  • Chest pain that worsens when you cough, laugh, or breathe
  • Hoarseness
  • Loss of appetite
  • Unintentional weight loss
  • Weakness
  • Recurrent bronchitis or pneumonia

You can find detailed symptom-related information on the American Cancer Society website. LDCT is the only test recommended for lung cancer screening. It is not a diagnostic test.

Insurance Coverage for LDCT

Most insurance companies and Medicare will cover the cost of LDCT lung cancer screening without the need for a copayment (out-of-pocket cost for the enrollee). However, it’s always better to call your insurance provider to confirm coverage benefits so that you don’t receive a surprise bill in the mail, such as in-network and out-of-network facilities.

Here is a helpful resource that can guide the conversation when you call your insurance company.

Those who are enrolled in Medicare may face coverage challenges if their screening test is conducted in what is known as an Independent Diagnostic Testing Facility (IDTF). The American College of Radiology and members from the Hours of Representatives have lent their support and urged the Centers for Medicare & Medicaid Services to oppose Medicare Administrative Contractors (MACs) who deny reimbursing IDTFs that conduct LDCT. Consequently, enrollees may have to cover the cost of the screening test out of pocket. What are MACs? MACs are private health insurance companies that process claims on the behalf of Medicare.

From the Editor:

Here is a great resource for those who are thinking of quitting smoking, with information on how to do it and why you should do it.

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Surabhi Dangi-Garimella

Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.

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