Does Insurance Cover Stem Cell Procedures?

Stem cell treatment advocates allege that the use of these special cells can repair diseased or injured tissue. Insurance companies consider most stem cell procedures experimental, so they will not cover such treatments in many circumstances.

TL;DR (Too Long; Didn't Read)

Since the idea of stem cell procedures is still considered experimental, insurance companies will not cover them. That being said, a majority of providers will offer financing options.

Private Insurance and Medicare

While insurance companies will not pick up the tab for many types of stem cell procedures, there are exceptions. These include the use of bone marrow stem cells for treatment of leukemia, lymphoma and multiple myeloma. Umbilical cord stem cells are used to treat many diseases, but most of this usage occurs in clinical trials, and insurance will cover these costs if the trial is approved by the Food and Drug Administration.

If an individual is under age 65 and thus not on Medicare, most private insurance companies will pay part of or all of cord blood and marrow stem cell procedures. Once the person turns 65 and must rely on Medicare, he is less likely to have the procedure covered. Medicare determines whether it will cover a marrow or cord blood transplant after, not before, the procedure. That means Medicare patients may be on the hook for the entire cost.

Even if Medicare does approve the procedure, its reimbursement rates do not cover the entire cost. The Miami Herald reports that hospital reimbursement rates average 47 percent less than the actual costs of care, with a loss of approximately $40,000 per patient.

Stem Cell Therapy and Surgeries

Many stem cell therapies are designed to help a patient avoid surgery. Unfortunately, insurance providers are far more likely to pay for at least some of the cost of stem cell treatment when the therapy is not considered experimental and is offered in conjunction with surgery, rather than instead of surgery. As with all major medical procedures, the insurance company must approve coverage and payment prior to the patient undergoing the treatment.

Stem Cell Coverage for Pets

While your insurance company may not pay for stem cell procedures, if you carry insurance for your pets, reimbursement for their stem cell treatment is likely. Embrace Pet Insurance, one of the nation’s largest such carriers, will pay for treatment for covered conditions. However, veterinary stem cell treatment is less regulated than that for human patients.

Financing Options

If your insurance doesn’t cover stem cell therapy, that doesn’t mean you’re out of options. Most providers offer financing options for these procedures, allowing patients to undergo the treatments and pay the costs in reasonable monthly installments.

The actual costs depend upon the type of stem cells used, the number of treatments needed and the condition for which the patient seeks therapy. Until insurance companies make changes in what they will cover regarding stem cell treatments, such financing remains the only option for desperately sick patients.

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