Is Stem Cell Therapy Covered by Insurance?

Currently, a few companies with private self-directed insurance, some workman’s comp, and the military (elite military units) cover your bone marrow aspiration concentration (BMAC) stem cell procedures, so check with your insurance provider to find out if your procedures are covered. Right now, no major insurance carriers are covering stem cell therapies. Basically, insurance companies are receiving the cost benefits of patients paying for these stem cell procedures themselves instead of pursuing surgical options that are covered by their insurance or using insurance-covered medication and physical therapy for long-term pain management. Additionally, the true benefit of live stem cell therapy is obscured by the less than reputable providers injecting and fraudulently billing Medicare for dead birth tissue allografts (amniotic, Wharton’s jelly, placenta) and calling it live stem cells. Lastly, they view it as a cost-plus procedure. If they cover the procedures, surgeons will begin to draw a small amount of bone marrow from any location adjacent to the surgery, squirt it directly onto the incision as they close, and also bill for a stem cell procedure. At some point, the major carriers will come on board with covering stem cell procedures. As they administer plans for privately insured companies, they will see the cost savings versus surgery. Once the highly favorable cost-benefit analysis is realized, they may approve the surgical option only if a standardized stem cell procedure using your own live cells by a nonsurgical specialized provider has failed as an alternative to surgery.

Eventually, the insurance companies will not be able to ignore that live cellular therapy using your cells is a safe, low-risk, nonsurgical alternative to surgery that does not require a lengthy and expensive hospital stay. Stem cell therapy can even improve some painful conditions that may not qualify for surgery but might require long-term medication or physical therapy to manage pain. The stem cell procedures do not require general anesthesia, just mild sedation, and patients may walk out of the clinic when the procedure is finished, resuming their normal everyday activities. All of these benefits mean significant cost reductions for insurance carriers.

Since 2014, Dr. Charles Lee has offered stem cell procedures at Regenesis. Only a small percentage of the 800+ patients who he has helped for conditions that might generally be referred to surgeons have eventually chosen to have a joint replacement. We are preparing our patient registry results for publication. Peer-reviewed research in the International Journal of Cell Biology showed pain and mobility scores for patients who had their own stem cell therapy improved more after two years than for patients who had total knee replacements, which fit with our preliminary data. With the well-documented success of stem cell therapy for decreasing the symptoms of osteoarthritis, arthritis, rheumatoid arthritis, and knee injuries, we predict insurance companies will begin to see stem cell therapy as an effective method for dramatically improving mobility and decreasing pain in patients, which should result in overall cost savings.

Aside from effectiveness, the noninvasive nature of stem cell therapy has significant advantages over traditional treatments like pain medication, physical therapy, and surgery. A patient’s specific diagnosis, age, overall health, and previous experiences with anesthesia are essential factors for consideration. With stem cell therapy, the risks of a reaction to general anesthesia are eliminated. Stem cell therapy also has zero risks of a patient’s body rejecting a new joint or needing a second surgery because of an ill-fitting joint. Without a surgical wound, patients don’t have to worry about wound care or possibly end up back in the hospital with a surgical infection. There is no risk of stem cell rejection because our cellular procedure uses your own live cells. All of these surgical complications often lead to higher costs for insurance companies, which could be avoided by covering regenerative medicine.

While stem cell therapies are not currently covered by routine insurance, they may still be less than the additive cost of many insurance policies’ co-pays and deductibles. Stem cell procedures carry lower risks than surgical procedures and are generally safer than surgery, so we expect insurance companies to recognize the benefits of stem cell therapy soon.

Book your consultation today at Regenesis by calling 256-715-8193 or filling out the contact form on our site.