Is Genicular Artery Embolization Covered by Insurance?

For individuals struggling with chronic knee pain due to osteoarthritis (OA), genicular artery embolization (GAE) has emerged as an exciting minimally invasive treatment that can provide long-lasting pain relief. However, before moving forward with the procedure, many patients ask an important question: Is a GAE procedure covered by insurance?

The answer isn’t always straightforward. Coverage can depend on several factors, including your insurance provider, policy details, medical necessity, and whether the procedure is FDA-approved for osteoarthritis treatment. In this blog, we’ll break down what you need to know about insurance coverage for GAE, how to navigate the approval process, and alternative payment options if insurance does not cover the procedure.

What Is Genicular Artery Embolization (GAE)?

Genicular artery embolization is a non-surgical, image-guided procedure that targets abnormal blood vessels in the knee to reduce inflammation and relieve pain caused by osteoarthritis. It provides a longer-lasting alternative to conservative treatments such as:

• Medications (NSAIDs, pain relievers)
• Steroid injections
• Physical therapy

Unlike knee replacement surgery, GAE preserves the knee joint and allows patients to maintain mobility while experiencing consistent pain relief. Additionally, GAE does not disqualify a patient from undergoing knee replacement in the future.

Does Insurance Cover Genicular Artery Embolization?

Insurance coverage for GAE can vary widely depending on:

Your Insurance Provider and Plan

Some private insurance providers recognize GAE as a medically necessary treatment for knee osteoarthritis, while others may still classify it as an emerging procedure.

Coverage may differ based on whether you have:

• Private health insurance (e.g., Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare, etc.)
• Medicare or Medicaid
• Employer-sponsored health insurance
• Supplemental or secondary insurance plans

While some private insurers may cover GAE, others may require additional documentation or preauthorization before approving the procedure. Don’t hesitate to call us for specific questions on coverage; we can help you through the process.

Medical Necessity and Physician Recommendations

Many insurance companies require proof that GAE is a medically necessary treatment. This typically means:

• You have tried and exhausted conservative treatments such as medications, physical therapy, and steroid injections.
• Your physician has documented chronic knee pain that affects your mobility and quality of life.
• You have undergone imaging tests (such as MRI or X-rays) that confirm osteoarthritis as the source of your pain.

Your specialist at Pedes Orange County can work with your insurance provider to submit the necessary documentation to increase the likelihood of coverage approval.

In-Network vs. Out-of-Network Providers

If your insurance does cover GAE, it’s essential to verify whether your specialist is in-network or out-of-network with your insurance plan.

• In-network providers typically have lower out-of-pocket costs for patients.
• Out-of-network providers may still be covered but could require higher copays or coinsurance.

At Pedes Orange County, we can help verify your coverage and explain your options before you schedule the procedure.

Steps to Check If Your Insurance Covers GAE

1. Contact Your Insurance Provider

Call the customer service number on your insurance card and ask:

• Is genicular artery embolization covered under my plan?
• What criteria must I meet for coverage approval?
• Do I need preauthorization before scheduling the procedure?
• What are my out-of-pocket costs (copay, deductible, coinsurance)?

2. Get a Referral and Preauthorization

Some insurance plans require a referral from a primary care physician or orthopedic specialist before approving treatment.

Preauthorization (or prior authorization) is a key step in ensuring that your insurance will cover the procedure. Your doctor will submit medical records and documentation to show that:

• You have tried other pain relief methods without success.
• You experience chronic pain affecting daily activities.
• Imaging confirms that GAE is an appropriate treatment for your condition.

3. Ask for a Cost Estimate

If your insurance covers GAE, request a breakdown of expected costs, including:

• Copayments
• Deductibles
• Coinsurance percentages

This will help you understand your financial responsibility before proceeding with the procedure, as these must be paid at the time of the procedure.

What If Insurance Doesn’t Cover GAE? Alternative Payment Options

If your insurance does not currently cover GAE, you still have options:

1. Health Savings Accounts (HSA) & Flexible Spending Accounts (FSA)

If you have an HSA or FSA, you may be able to use these funds to cover some or all of the procedure costs.

2. Financing Through Medical Credit Programs

Many patients use medical financing programs like:

• CareCredit
• MedLoan Finance
• Bank financing options

These programs allow affordable monthly payments rather than paying the full cost upfront.

3. Discuss Alternative Insurance Plans

If your current insurance does not cover GAE, some patients explore alternative insurance plans during open enrollment periods that may offer better coverage for interventional procedures.

Is GAE Covered by Insurance?

Insurance coverage for genicular artery embolization (GAE) can feel like a complex process, but understanding your options can help you make an informed decision. While some insurance providers offer coverage for the procedure, approval often depends on demonstrating medical necessity and obtaining prior authorization. For those seeking an alternative to knee replacement surgery or longer-lasting relief than medications and injections provide, GAE can be a valuable option. If insurance coverage isn’t available, flexible payment plans, HSAs, FSAs, and financing programs can help make the procedure more accessible.

At Pedes Orange County, we understand that every patient’s situation is unique. Our team is here to guide you through the process, from verifying insurance benefits to exploring financing options so you can focus on what matters most — finding relief from knee pain and improving your quality of life. If you’re considering GAE and want to learn more about your coverage or payment options, schedule a consultation today and let us help you take the next step toward lasting comfort and mobility.