Is Platelet-Rich Plasma Covered by Insurance? All Questions Answered

Would you like to learn the reply to the question ‘is there any possibility to get the treatment with PRP covered by insurance?’ Then read further to see if this is possible.

PRP therapy has been used for decades for treating the injuries of knees, shoulders, or other joints and is mostly applicable in sports and athletic environments. The 21st century has broadened a list of applications for this kind of treatment, so today it is used for erasing cosmetic defects of the skin, curing hair loss, healing the postsurgical stitches, and much more.

Let’s see what PRP exactly is, how useful it can be for your particular health issues and what perspectives of insurance coverage for PRP are anticipated in the nearest future.

What is PRP?

PRP is spelled out as platelet-rich plasma and defined as a substance made from the blood with the help of centrifugation. A small blood sample is taken from a patient to be placed into a tiny vial which is then spun in the centrifuge to separate three layers with red blood cells, white blood cells, and platelets.

Plasma rich with platelets is that magic ingredient that makes PRP therapy possible. This is the platelet-rich plasma that is so precious thanks to its high aggregation of growth factors, proteins, and platelets assisting in the recovery process of human tissues as well as being keen on promoting skin restoration and collagen production.

What is PRP treatment and how much does it cost?

PRP treatment supposes both injections and microneedling. The way of utilizing PRP depends on the site of the body to be healed. For instance, if plasma is used for joints, hair scalp, or the under-eye area, then the treatment is provided in the form of injections. If PRP is used on the face and neck area, then doctors prefer the method of microneedling.

Why are people looking for PRP covered by insurance? Actually, PRP treatment is pretty expensive, so the average cost of a standard PRP course can reach up to $2.500. The price can be just a bit less or more depending on the number of procedures required, the site of the body to be treated, and even the location of a clinic and its particular price policy.

Insurance Providers’ Attitude to PRP Treatment

For now, most insurance providers don’t cover PRP procedures as it is offered as a ‘fee-for-service’ type of therapy. This means that more opportunities to be potentially brought by this type of therapeutics are still under the research, so if the patients want to test its efficiency on their own, they should pay for it from their own pocket.

When it comes to PRP for the face, insurance companies never cover such types of services as they are considered to be cosmetic ones, and esthetic therapy is not qualified as the vital necessity to be compensated by any insurance payments.

Is it possible to get full reimbursement for PRP?

A host of researchers and PRP lawyers are fighting for the possibility for people to get treatment with PRP covered by insurance. It is believed that platelet-rich plasma can replace a large number of surgical interventions. Medical experts are sure that PRP has already proved its efficacy in a number of practices, so it deserves to be covered by insurance providers.

Blue Cross Blue Shield and PRP Coverage

PRP injections are often made to cure tendons and ligaments to strengthen them and promote healing by stimulating endogenous repair mechanisms. The aims in healing the joints are reached thanks to the high concentration of platelet-based growth factors. Some insurance companies can cover PRP treatments in case they are used for treating musculoskeletal pain conditions.

For instance, Blue Cross Blue Shield has a subject-related policy titled “Growth Factors in Wound Healing”. This policy states that BCBSNC is ready to cover PRP services if they are medically necessary. However, some specific medical criteria and guidelines should be met.

The guiding principle of this insurance provider is as follows:

Plasma rich with platelets and growth factors used for managing wounds is considered medically indispensable if it is utilized as an adjunct to topical wound treatment. Key indications include neuropathic diabetic ulcers and pressure ulcers extended to the subcutaneous tissue.

Using PRP-originated growth factors in healing the wounds are not covered by Blue Cross Blue Shield in the case if they are used for purposes that are considered to be investigational.

Such purposes include using PRP for ischemic and venous stasis ulcers as well as using it for ulcers that are not extended through the skin into the subcutaneous tissue. Treating chronic, acute, and surgical wounds as well as maintaining non-healing ulcers is also not supposed to be covered by insurance.

What are PRP lawyers fighting for?

Currently, PRP lawyers are working to reach some coverage for PRP procedures from insurance companies, so they want to fulfill the following goals:

1. Collect all the available results of research that confirm the efficacy of platelet-rich plasma.
2. Match huge volumes of information from medical experts who provide PRP treatments on a daily basis and get a handle on how effective plasma is for real patients who use it.
3. Encourage scientific institutions to make more research on platelet-rich plasma.
4. Compile the detailed charts on cost comparison to prove that PRP is a less expensive alternative as compared to surgery and confirm that such therapy can supplant the costly surgical interventions.

The main goal is to make insurance companies realize how many costs they can save by preventing certain types of surgical procedures and by starting to cover PRP treatments instead.

Lots of insurers cover injections of corticosteroids despite the fact that this kind of treatment is potentially harmful and not as effective as platelet-rich plasma for certain medical conditions.

I should say that the process of convincing the insurers that platelet-rich plasma is a very effective method with a wide range of possibilities is a promising perspective for lawyers.

What are the hidden reefs?

Today a lot of people use hyaluronic acid dermal fillers for anti-aging facial treatments, but such injections aren’t recommended by experts to be used on a regular basis because this can lead to degeneration of tissue and the inability of the body to regenerate itself in a natural manner.

Lots of folks, in their turn, use corticosteroids for treating issues with joints, but such treatment has a number of side effects as well as the risk of osteoporosis.

PRP would be a great alternative for curing certain health conditions or eliminating skin issues without any risks and potential disorders. However, PRP injections and microneedling procedures are a costly ‘party’ for lots of Americans who can’t afford to make such expenses from their own pocket.

There is a big chance that in the nearest future PRP injections are going to be covered by insurers especially when it comes to treating some chronic conditions, replacing dermal fillers and corticosteroids.

For now, you can feel free to learn the replies to any questions concerning platelet-rich plasma therapy for any health condition or esthetic purpose you require. Get in touch with a team of our professionals, and one of them is going to get in touch with you as fast as possible.