My insurance company denied payment for ultrasound treatment I received in Canada for a fractured tibia. The notice said it wasn't "medically necessary." Why not? When would it be medically necessary?

Each third party payer makes its own rules and guidelines about payment for services. The same is true for what is considered medically needed or unnecessary. In the case of ultrasound treatment for bone fractures, the following is a list of when some companies will cover this treatment method:

  • When there is high risk for delayed fracture healing or nonunion. This depends on where the fracture is located.
  • When other health concerns are present such as diabetes, smoking, osteoporosis, or steroid therapy.
  • At least three months have passed since the fracture occurred.
  • More than one X-ray has shown no sign of healing.
  • The fracture gap is one cm or less.
  • The patient must be able to avoid weight-bearing activities.

    The fracture cannot involve the skull and vertebra. The patient can't have cancer or active osteomyelitis.

    Check with your insurance company for more detailed information. Most companies don't reimburse for its use at this time. More studies are needed to prove it's a cost savings treatment.

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