Brain and Cerebrovascular MRI Covered by Health Insurance for Suspected Brain Diseases
Full Cost Borne by Patient for Simple Headache and Dizziness Tests
Starting this month, patients who undergo brain and cerebrovascular magnetic resonance imaging (MRI) at hospitals for simple headaches or dizziness may face a 'medical bill shock,' so caution is necessary.
Patients bear full cost for MRI scans due to simple headaches or dizziness... "Health insurance support provided if medical validity is proven"
According to the Ministry of Health and Welfare on the 6th, from the 1st of this month, patients undergoing MRI scans for simple headaches or dizziness?excluding headaches and dizziness suspected by a doctor to be related to brain diseases such as cerebral hemorrhage or cerebral infarction?must bear the full cost of the examination themselves.
If a doctor judges that an MRI scan is medically unnecessary but the patient requests it for simple migraines or chronic dizziness, health insurance will not apply.
An official from the Health Insurance Policy Division of the Ministry of Health and Welfare pointed out, "There have been many cases where patients received multiple unnecessary tests when visiting hospitals for symptoms like headaches or dizziness, which caused excessive spending of the National Health Insurance funds."
He added, "We have reviewed unnecessary test items and improved the system so that only medically necessary tests are supported by health insurance."
MRI medical expenses surged over 10 times from 14.3 billion KRW in 2017 to 176.6 billion KRW in 2021
The government strengthened the coverage criteria for brain and cerebrovascular MRI because the utilization of these tests surged after expanding health insurance coverage for MRI and ultrasound as part of the health insurance coverage enhancement measures, increasing the financial burden on the health insurance system.
Specifically, medical expenses for brain and cerebrovascular MRI were 14.3 billion KRW in 2017 but skyrocketed to 176.6 billion KRW in 2021 after the expansion of insurance benefits.
Until September, when patients underwent MRI scans for headaches or dizziness, health insurance benefits were uniformly recognized for up to three complex scans regardless of neurological examination abnormalities or the patient's condition and medical necessity.
However, starting this month, patients diagnosed with brain diseases or those showing abnormal findings in neurological tests such as brain nerve examinations or limb motor function tests can receive insurance benefits for MRI scans. This is also limited to a maximum of two scans.
The Ministry of Health and Welfare outlined suspected brain disease headaches as follows: ▲Sudden, severe headache like being struck by lightning experienced for the first time in life ▲Headache accompanied by flashing lights or visual loss ▲Severe headache accompanied by runny nose or conjunctival injection lasting several days or more ▲Headache worsened by coughing or straining during bowel movements ▲New severe headache in children or headaches that intensify over several months ▲Headache different from usual in cancer patients or those in immunosuppressed states.
For dizziness, the types include ▲Dizziness accompanied by eye (ocular) movement changes in specific postures ▲Difficulty walking or maintaining balance along with dizziness ▲Sudden hearing loss accompanying dizziness.
Meanwhile, a survey conducted by the Health Insurance Review and Assessment Service in 2020 on 732 hospital-level or higher medical institutions found that the average cost of brain MRI was 457,803 KRW. The maximum was 885,000 KRW, and the minimum was 250,000 KRW.
© The Asia Business Daily(www.asiae.co.kr). All rights reserved.
