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Insurance and Cellular Therapy: Why Isn’t It Covered?

13 Apr 2016
| Under COPD, FAQs | Posted by | 58 Comments

It’s an understandable question, so let’s get right to the point.

From chronic obstructive pulmonary disease (COPD) to cancer, new forms of treatment are being discovered every day for the diseases we endure. However, the distance between discovery and being fully covered by HMOs can be vast. Although the benefits of an emerging treatment may be readily apparent through its use and further research, often, the delay between widespread application and coverage can simply be time.

So How Do Emerging Treatments Get Covered?

For your peace of mind, the Lung Institute is here to breakdown and provide a simple answer to a complex question regarding Insurance and Cellular Therapy: Why Isn’t It Covered?


Insurance and Cellular Therapy: Why Isn’t It Covered?

To begin, there are forms of cellular therapy that are currently covered by traditional insurance companies. These treatments typically include bone marrow transplants for diseases of the blood such as leukemia. Although the practice of using cellular therapys- such as bone marrow transplants- has been in use since the 1970s, as the understanding of cells has continued to develop, so too has its use in addressing other diseases.

As the field of cellular therapy continues to progress, it has led to advancements in treating multiple sclerosis, heart disease, blindness, rheumatoid arthritis and even baldness.  As each new application of cellular therapy is discovered, it begins its own unique development process.

General Timeline

Insurance and Cellular Therapy: Why Isn’t It Covered?

  • After scientific research has led to a new method of treatment being discovered, the first step within its development is animal testing.
  • Once scientists are confident the effects can be controlled and replicated in humans, clinical trials are begun.
  • After human clinical trials are conducted and approved for use, the treatment can be used in general medical practice.
  • As the emerging treatment begins to see widespread use and appeal, various medical associations and agencies will examine the treatment, deciding whether or not it should be included within the standardized treatment regimen of the disease.
    • For example, in lung disease, the general regimen followed by physicians and pulmonologists is to prescribe an inhaler, medication, oxygen therapy, and ultimately a lung transplant, depending on the stage and severity of the disease.
  • When an emerging treatment is added to a standardized treatment regimen, it is given a Current Procedural Terminology (CPT) code by the American Medical Association (AMA).
  • This code is meant to facilitate communication between medical specialists and insurers, and typically leads national social insurance programs such as Medicare and Medicaid to eventually cover treatment.
  • Once the emerging treatment is accepted for coverage by Medicare and Medicaid, coverage by traditional HMO’s is generally soon to follow.

What This Means for the Future

Insurance and Cellular Therapy: Why Isn’t It Covered?

Although the process for an emerging treatment to be covered by traditional insurance companies can take time, the use of cellular therapy- in the treatment of lung disease- has made tremendous strides in recent years. With every passing year, the benefits of cellular therapy are felt by a greater number of patients, and as cellular research continues to develop, a future where cellular therapy is fully covered may be here sooner than expected.

Time can be a factor in any decision, so if you’re looking to take control of your health, don’t wait. If you or a loved one suffers from COPD or another lung disease, the Lung Institute may be able to help with a variety of cellular therapy options. Contact us at 888-745-6697 today to find out if you qualify for cellular therapy.

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* Every patient is given a Patient Satisfaction Survey shortly after treatment. Responses to the 11-question survey are aggregated to determine patient satisfaction with the delivery of treatment.

^ Quality of Life Survey data measured the patient’s self-assessed quality of life and measurable quality of improvement at three months of COPD patients.

All claims made regarding the efficacy of Lung Institute's treatments as they pertain to pulmonary conditions are based solely on anecdotal support collected by Lung Institute. Individual conditions, treatment and outcomes may vary and are not necessarily indicative of future results. Testimonial participation is voluntary. Lung Institute does not pay for or script patient testimonials.

As required by Texas state law, the Lung Institute Dallas Clinic has received Institutional Review Board (IRB) approval from MaGil IRB, now Chesapeake IRB, which is fully accredited by the Association for the Accreditation of Human Research Protection Program (AAHRPP), for research protocols and procedures. The Lung Institute has implemented these IRB approved standards at all of its clinics nationwide. Approval indicates that we follow rigorous standards for ethics, quality, and protections for human research.

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