It is common knowledge throughout the regenerative medicine industry that health insurance companies do not cover the vast majority of procedures being performed in the United States. All they cover are bone marrow transplants and PRP injections that promote post-surgical wound healing. It’s time to challenge insurance company thinking. The insurance industry has nothing to lose by embracing regenerative medicine as an alternative to traditional treatments.
For the record, this is not to say that every regenerative medicine procedure should be considered worthy of being covered. This article focuses on a rather small number of procedures that are provided under existing FDA rules and have already been deemed safe by federal regulators. They include PRP and stem cell injections for musculoskeletal injury and disease.
To make it easier, we will focus on PRP and stem cell injections as a treatment for osteoarthritis. As you may already know, osteoarthritis is the most common form of arthritis in the world. The vast majority of adults will suffer from it to one degree or another at some point in their lives. Traditional treatments include pain medications, steroid injections, and joint replacement surgery.
The Insurance Industry Position
Despite a growing body of evidence showing that regenerative medicine can improve osteoarthritis pain, insurance companies refuse to cover PRP and stem cell procedures. Apex Biologix explains their rationale: insurance companies consider regenerative medicine to be largely experimental. They will not cover it because they do not believe it actually works.
There was a day when chiropractic and acupuncture were both considered experimental by insurance companies. Neither was covered by the average health insurance policy. Why has that changed? Have chiropractic and acupuncture changed in the eyes of the FDA? No. Insurance companies now cover chiropractic and acupuncture because they have discovered they can save money by doing so.
At issue here is what makes regenerative medicine experimental. If the only qualifying factor is FDA approval, then you could make a case for the experimental status of PRP and stem cell injections – but only based on the fact that the FDA has never sanctioned such procedures for their efficacy. Both PRP and stem cell injections for osteoarthritis are already approved by the FDA for their safety. They are also regulated by the FDA.
Regenerative Medicine Saves Money Too
What insurance industry leaders fail to realize is that regenerative medicine procedures can save them money, too. In fact, the procedures can save a lot of money compared to joint replacement surgery. At a few thousand dollars per injection, a patient requiring even five stem cell treatments to realize the relief he needs will still cost his insurance company a lot less than would be paid for surgery.
Another thing to consider is that PRP and stem cell treatments are virtually risk-free. There are almost no complications, which means not having to pay for future procedures meant to solve problems caused by the original treatment. The same cannot be said for joint replacement surgery.
When looked at from a bottom-line perspective, the insurance industry has nothing to lose by agreeing to cover certain regenerative medicine procedures. And if they are really that concerned about losing money, they could say to a patient that she must choose one or the other. If she chooses stem cell injections, they will not cover future surgery. That would save them a ton of money all the way around.
It’s time for regenerative medicine to be given a place at the table alongside chiropractic, acupuncture, and more traditional treatment options. Insurance companies have nothing to lose and everything to gain.