Why DON'T all providers accept insurance for thyroid RFA procedures?
This is a frequently asked question and is understandably frustrating for patients who pay insurance premiums
What is thyroid RFA and who should consider it?
Eager to avoid thyroid surgery
Today, many patients are eager to avoid thyroid surgery as a treatment option for thyroid cysts, nodules, and some cancers. For some, the primary motivation is to avoid having a prominent neck scar. For others, they carry more than physical scars from a previous negative surgical experience. But often, its because a patient knows someone who has had a bad outcome after thyroid surgery (usually related to not feeling right on the life sentence of thyroid medication).
Thyroid medication was the third most prescribed drug in 2022.
Insurance coverage…or lack thereof
Patients are excited to save their thyroid; their demand for surgical alternatives is increasing the availability of thermal ablation providers in the US, particularly those offering radiofrequency ablation (RFA). However, their excitement is often dulled by inconsistent insurance coverage available.
Currently, many thyroid RFA providers only accept cash for the thyroid-sparing procedure. Many providers have fought long and hard with insurance companies and simply haven't made any progress. It's not uncommon for insurance companies to say that thyroid RFA is an experimental procedure. If your insurance company says this to you, don’t let them off the hook easily. Tell them this statement is absolutely false, because thyroid RFA was FDA cleared in November 2018.
Some providers have had insurance companies or Medicare provide extremely low amounts of reimbursement, often reimbursing like the procedure is a biopsy --as little as $200-- which is not even close to enough to cover the provider's own procedure costs (generator, single use probes, and disposable sterile items).
Even worse, insurance companies can and have requested the return of reimbursement funds up to 18 months afterwards! Repeatedly enduring this makes offering thyroid RFA unsustainable for the provider. These physicians and their institutions have to earn enough money to be able to pay for not only their RFA equipment/supplies, but also their office space, support staff, and professional time. Otherwise, they cannot stay in business and would have to stop offering this alternative to thyroid surgery. As admirable as it is for doctors to help patients, they also have to pay their bills and feed their families. What truly is admirable is that providers take the financial risk to offer this nonsurgical procedure, not knowing if they will even have adequate patient response. Many providers are doing all they can to ease the financial burden on patients by offering payment plans, financing options, etc. for thyroid RFA.
Hope for the future of thyroid RFA
Once a CPT code is created for thyroid RFA by the AMA and insurance companies see their financial benefit to offering reimbursement, this situation WILL change. Unfortunately, no one knows when that will come to fruition, and providers don't have any control over it. If a patient wants a nonsurgical option for treating thyroid nodules that may be covered by insurance, laser ablation does currently have a CPT code (it is a temporary code and does not guarantee coverage). However, there aren't as many providers of this treatment option yet and patients will very likely need to travel to access it, which adds to their out of pocket cost.
What is laser ablation for thyroid nodules?
Comparing the costs
What's important for patients to consider is the comparison of out of pocket costs for the available treatment options. If you choose to undergo a thyroidectomy which is covered by insurance, your out of pocket costs may be very similar to those of a cash-pay RFA; BUT, there will be the addition of the surgical recovery/time off work, cost of medications for the rest of your life, etc. With either option, there will be costs associated with continuous medical follow up.
Patient education is vital
Ultimately, there is no universally right or wrong decision regarding the treatment of thyroid nodules; it is a patient's decision PERSONALLY to make, with the guidance of a trusted physician, giving consideration to your personal health needs, priorities, and financial circumstances. As always, I highly encourage patients to get multiple opinions from TRAINED thyroid ablation providers in various medical specialties (Please, make sure they have been trained in the modality you are seeking!). Also, utilize the educational resources in our patient community and on my YouTube channel. Once you have educated yourself, THEN make an informed decision about your thyroid nodule care. Its up to you to be your own advocate.
Find a thermal ablation provider here.
Whatever a patient decides, Save Your Thyroid here to help educate and encourage them on the journey.
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