Is Stem Cell Therapy Covered by Insurance

One of the most common questions we’re asked regarding stem cell therapy and platelet rich plasma (PRP) is whether or not these procedures are covered by insurance. As new medical techniques develop over time, all aspects of modern medicine need to be adaptable to changing methods, and insurance providers are no exception. The healing potential of stem cells are among the most exciting areas currently developing within medicine, both in the orthopedic field and beyond, with orthopedic stem cell treatments having shown impressive healing results time and time again! However there are also plenty of other areas of medicine where the capabilities of stem cells are very much in their earlier stages of development, and in turn, that much farther away from the regulatory approval that is often required for a service to be covered by medical insurance. Much of the challenge moving forward lies in determining what new medical technologies, and particularly what types of stem cell treatments, can and will become prominent treatment options for the foreseeable future.

Unfortunately the stem cell therapy treatments that we offer here at South Valley OrthoMed are not currently billable to any known insurance providers. However at an out-of-pocket price of $1,950, South Valley OrthoMed offers orthopedic stem cell therapy treatment at one of the best overall values found anywhere!

But why isn’t it covered?

Orthopedic stem cell therapy is currently categorized as FDA Cleared, however as was mentioned earlier, stem cells are being used in many different areas of medicine. Plenty of these treatments are still very experimental, with results not replicated often enough to truly be considered as viable treatment options. As a result, it appears to be the case that insurance providers are waiting until there’s a much better understanding of all of it, before they’ll be covering any of it. In other words, with so many new medical technologies developing over time, differentiating between what has true long-term viability and what might just be a passing fad is an important distinction that insurance providers will want to make.

I spoke to my insurance and they said it is covered!

Several times here at our clinic, we’ve encountered a misunderstanding where certain insurance provider representatives have told prospective patients that stem cell therapy would be covered under their plan. This unfortunately is not the case. This miscommunication refers to a type of bone marrow/stem cell transplant for treatments related to conditions such as leukemia, Hodgkin’s Disease, and others. These treatments do not go into areas such as orthopedic use, and despite the miscommunication that has appeared to happen on several occasions, orthopedic treatments with stem cells are still indeed not yet covered under insurance.

Moving forward:

It’s impossible to say when orthopedic stem cell injections might be covered under insurance. With ongoing clinical testing and almost countless success stories, it seems like an inevitability down the road, we just don’t know how long that road will be. Considering the drastically reduced cost of stem cell therapy in relation to an alternative and more traditional treatment like knee replacement surgery, one would think stem cell therapy is something the insurance providers SHOULD be in a rush to cover. With lower cost procedures the can yield significantly better results than traditional treatments, one has to think it will happen sooner rather than later.