Insurance Coverage and Stem Cell Therapy: What You Need to Know
Over 50% of adult Americans cannot afford medical treatment. Currently, there are lots of benefits of stem cell treatments but one of the biggest challenges with patients is their high costs.
The basic points of stem cell therapy and the stem cell price, insurance considerations, and other funding options are explored in this article.
What is Stem Cell Therapy?
The use of stem cells in regenerative medicine functions through stem cells for tissue assistance and immune regulation, as well as healing stimulation. Stem cells employed for medical treatment consist of the following types:
- The tissue spaces containing Adult Stem Cells (ASCs), especially bone marrow and fat, serve to treat broken tissues
- Sequencing of adult cell genetics to replicate embryonic stem cell characteristics produces Induced Pluripotent Stem Cells (iPSCs).
- MSCs serve orthopedic and autoimmune conditions through their inflammation reduction and tissue repair properties, because of which they find applications as Mesenchymal Stem Cells (MSCs).
Due to the potential of stem cell therapy — not all treatments are FDA-approved — its application varies and the lack of coverage for the stem cell infections cost is directly tied to insurance availability.
The Cost of Stem Cell Therapy
The average stem cell price for treatment per patient can be from €7,000 to €19,000. Influencing the price are some of the factors such as:
- How to differentiate between Autologous (from the patient’s own body) and Allogeneic (from a donor) stem cell source.
- Some treatments involve several injections, extensive laboratory processing, and hospitalization.
- Costs may vary widely depending on the clinic or country.
- FDA-approved treatments may be more likely to get insurance coverage, while the experimental treatments are self-paid.
Given these high costs, it is rather important for many patients hoping to have stem cell therapy to understand insurance options.
Understanding Insurance and Stem Cell Therapy
Most stem cell therapies, such as Swiss Medica, are categorized as experimental or investigational treatment and thus are not covered by most insurance providers.
- Most bone marrow transplants for leukemia receive insurance coverage because they are widely approved by authorities.
- The insurance industry considers experimental regenerative stem cell treatments along with numerous other treatments that stem from stem cells, to fall under this exclusion category.
- Other qualified personnel can provide services that do not qualify as covered therapy nor result in insurer reimbursement.
What Types of Insurance Might Cover Stem Cell Therapy?
The stem cell procedure cost may differ according to the type of insurance.
- Stem Cell Treatments and Private Health Insurance: Most private insurers are not willing to cover stem cell treatment unless it is FDA-approved and medically necessary.
- Medicare and Medicaid: Cover only certain conditions (for example, stem cell transplants for blood disorders) and only when those conditions are required as a result of an accident.
- In some cases, stem cell therapy is used to treat injuries that result from the work and are paid for through workers’ compensation.
- Some insurers may pay for participation in clinical trials that employ stem cell treatment as part of a protocol.
Regenerative treatment policies found outside of the U.S. may have broader coverage.
How to Navigate the Insurance Process for Stem Cell Therapy
Getting insurance coverage for stem cell therapy is tough. However, patients can take some steps to boost their odds:
- FDA approval: Make sure that the stated treatment is FDA-approved, which will increase the chances that insurance will pay for it.
- Review Insurance Policies: Look at insurance policies carefully and see what treatments are covered.
- Get a Doctor’s Recommendation: A letter from a healthcare provider giving an explanation of the medical necessity for the treatment may be useful.
Having a medical billing specialist or a patient advocacy group to consult may increase the likelihood of coverage.
Alternative Financing Options
Alternative financing options are available for patients who are unable to receive coverage for stem cell therapy.
- Medical loans: There are many financial institutions providing loans for medical treatment.
- Successful utilization of Websites such as GoFundMe to raise funds for expensive medical procedures.
- Stem cell therapy research studies: some eligible patients are given free or reduced-cost stem cell therapy.
- Employer Assistance Programs: Some employers aid towards the financial costs and/or offer insurance plans in which regenerative medicine is an option.
In addition, international medical tourism, where people travel abroad to have treatment more cheaply in countries where stem cell therapy is a profitable option, carries its risks.
Future of Insurance Coverage for Stem Cell Therapy
Therapies will undergo clinical trials and if these treatments are approved by the FDA, then insurance companies may start to cover those as well. Some important developments include:
- Broad Insurance Coverage: Wider coverage of insurance may be brought about by more therapies being granted regulatory approval.
- Evidence and Research Expansion: The more scientific proof of stem cell therapy, the greater insurers may be willing to cover it.
- Government policies and healthcare reforms would affect the way in which regenerative medicine would be paid for.
Regenerative medicine is included in some employer-based initiatives.
Final Thoughts
This therapy has great potential for treating different medical conditions but the stem cell procedure cost and lack of universal insurance coverage discourage many patients. However, with the field in its nascent stages, it is hoped more people will begin to gain access to insurance coverage and, ultimately, have access to stem cell therapy if they need it.
