Will Insurance Cover Stem Cell Treatments? Medicare and Blue Cross Blue Shield Policies

Multiple researchers have already recognized stem cells treatment to be effective for the conditions like knee or shoulder arthritis, meniscus sprain, rotator cuff tears, and more joint disorders. These cells are considered to be a part of regenerative medicine and a great alternative to avoiding surgery while getting long-term relief.

The sensational self-renewing ability of mesenchymal stem cells that allows them to continuously divide to become specialized organs and tissues makes them an irreplaceable method of treating any harmful disorders from back pain to erectile dysfunction.

Lots of people potentially ready to try regenerative medicine to overcome their health issues ask if this treatment is covered by their current health insurance plan. In today’s post, we’ll try to answer the question “does insurance cover stem cell therapy?” So, let’s start!

Stem Cell Insurance: What do they pay?

In the US, cellular therapy is still regarded as an experimental treatment; this is why stem cell injections are not covered by insurance plans. However, some insurers can pay for a doctor’s consultation or indemnify other associated costs incurred during the therapy in total and every procedure in particular.

Despite the fact that stem cell treatment is a pretty expensive process, a patient has a good opportunity to get a fully transparent accounting of costs expected in a single payment before the first regenerative procedure. If you choose a reputable clinic, you are going to receive a detailed individually customized treatment plan with all the services and prices explained.

Usually, health care providers base their prices around the following factors:

• timespan a patient has been suffering from a certain disorder;
• the number of cells required for effective treatment results;
• how many organs or tissues in the body require cellular treatment;
• the severity of a patient’s condition.

Considering the mentioned factors, clinics usually charge from $900 up to $6.000 for stem cell therapy (meaning the cost per a single procedure or a full course consisting of a prescribed number of injections).

The procedures can be spaced out to make a financial ‘pressure’ for a patient a bit lower, but this is discussed individually.

Does insurance cover stem cell therapy? Medicare Health Insurance

Many older people are suffering from arthritis and are probably interested in insurance coverage of stem cell therapy for knees or other joint diseases because paying out of their own pocket is a comparatively tough task. Let’s see what possibilities of insurance coverage are offered by Medicare.

Medicare is federal health insurance for people older than 65, younger people with disabilities, and people with End-Stage Renal Disease which is a permanent kidney failure requiring dialysis or a transplant.

Medicare offers coverage only for FDA-approved (allogeneic and autologous) hematopoietic stem cell transplants that are therapies promoting the growth of healthy blood cells. Such therapy is used for combating serious diseases like:

• sickle cell disease;
• lymphoma;
• Waldenstrom macroglobulinemia;
• acute myeloid leukemia;
• testicular germ cancer;
• immune system disorders;
• more blood disorders and cancer.

When it comes to the stem cell injections for knees they are not covered by this organization in particular. However, Medicare can cover other treatments for joints like physical therapy, nonsteroidal anti-inflammatory drugs, corticosteroid injections, nerve blocks, hyaluronic acid injections, topical gels for knees available over the counter as well as knee surgery, and knee replacement.

Will insurance cover stem cell therapy? Blue Cross Blue Shield

Researchers have studied the potency of stem cell injections into cartilage and other damaged tissue to decrease the issues caused by knee osteoarthritis. Articles published in PMC (US National Library of Medicine National Institutes of Health) in 2020 show encouraging results seen in medical trials.

The studies have found that stem cell treatments for knee arthritis are better than conservative treatments like taking anti-inflammatory medications.

However, the current data is limited, and mesenchymal stem cell therapy is still considered to be investigational for all orthopedic applications such as, for instance, repair and regeneration of musculoskeletal tissue.

The policy of Blue Cross Blue Shield states that experimental or investigational procedures, drugs, treatments, or devices are not covered by its insurance plans.

However, there is a chance to get insurance coverage if you ask a doctor to submit a predetermination of benefits request for the insurer to verify if stem cell therapy would be eligible for coverage under your particular insurance plan’s benefits.

No matter whether you prefer receiving stem cell treatment with or without insurance, you won’t regret turning to this type of regenerative medicine. Using mesenchymal stem cells for the treatment of multiple disorders from arthritis to liver diseases is a cutting-edge method to be as casual in medicine as taking the pills or inhaling.

Got more questions concerning insurance and payments available for your stem cell therapy? Be sure to contact us now to get free assistance from our qualified experts! We are always happy to help!