Patients ask me all the time about stem cell treatments. Some are curious. Some have already had treatments. Others are very seriously considering a treatment, but haven’t done so yet. Some are open-minded. Some are not. Some are angry with me for my track record of criticizing for-profit, unlicensed clinics offering stem cell treatments.
In this new blog series, I’m going to go step by step through 8 reasons why I would not recommend that patients get unlicensed stem cell treatments from clinics.
Today’s post, Part 1, focuses on insurance.
Obama won the election and Obamacare was approved of by the Supreme Court so it would seem it is here to stay. I’m happy about that. It increases the number of people who have health insurance. However, of course, insurance companies won’t necessarily cover everything or everyone. In addition, the decisions that patients make also influences how protected they are from disaster via health-related expenses.
What many patients may not realize is that choosing to get an unlicensed stem cell treatment can have profound, negative implications for one’s health insurance.
If you choose to get an experimental stem cell treatment from an unlicensed clinic, you have basically handed your insurance company an iron clad excuse not to cover many different health-related issues that might come up for you after that. For example, if you have the misfortune of getting an infection from the stem cell treatment that lands you in the hospital, your insurance company will not cover the costs that could go easily go into the hundreds of thousands of dollars. The same is true for the kind of autoimmune reactions that some patients have had after adult stem cell treatments. If they land you in the hospital even for just several days, the bill may be sky high and your insurance company will just say “sorry, you are on your own”.
Even if the health-related problem you have after your stem cell treatment was, in your opinion and may even in the opinion of the doctor who administered the treatment, not a direct result of the transplant, your insurer may believe otherwise and deny you coverage.
For example, if a few years down the road you get cancer, the insurance company may claim it was due to the stem cell treatment and deny you coverage.
Think about it.
Stay tuned for part 2 of the series next week.
It would be great if someone legal could get official written statements from the major health insurance companies about unlicensed cell therapy complications and whether they would or would not pay for care. Then the patients would have equipment to fight with if they are denied care. Also what would be the upper and lower limits on this care, if it could be shown that the treatment created an auto immune complication would this be treated like any pre-existing condition?
Could people by a rider etc. It is likely that someone denied could actually fight as some self induced harm is covered so why not someone’s attempt to extend life. It is wonderful that Obama Care can do away with pre-existing condition denial penalties etc but that doesn’t come into effect immediately so what if anything could be done now?
It is a grey area though as some self harm like suicide leads to denial of benefits and in auto crashes for instance the award can be reduced by who was at fault or pre-existing but until truama dormant conditions.
I am concerned with the common delay defend, deny and accuse cycles that remain a tragic fight for someone who is already fighting for their health and sometimes their lives. The patients report they do not have the luxury of time and are prepared to take whatever risk they must and are willing to bankroll this. The logic there is that when there is a fire you use the hose you have got and that that is not the time to make hose inspections.
I understand the implications but once patients choose to have the treatments regardless of legal status are their ways to protect the life they have left and reduce their stress. This should not be the patients battle
I’m a lawyer with significant experience in suits against insurers, but I cannot claim to have confronted this particular issue. The comments conveyed by Dr. Centeno are consistent with usual insurer behavior. But that’s the only support I know of for the position you argue. I recently went through a change of health insurers to BCBS and there are no terms to exclude coverage based on prior treatment not FDA approved, or simply offshore. And once “Obamacare” takes full effect in 2014, a pre-existing condition is no longer a basis for excluding coverage. Finally, I cannot imagine why a confidential source cannot share with you a citation to a supposedly controlling contract term supposedly ubiquitous through health insurance policies. Your overall argument may well be correct, but reason number # 1 seems to lack supporting evidence.
Paul,
This is our clinical research director’s take on the issue (he’s been running studies for the past two decades):
“Dr. Centeno,
Per our conversation yesterday: I have heard of instances where a study subject was denied insurance coverage for an injury related to a investigational care, but it was because the trial Sponsor had in their informed consent that they would pay for medical costs related to subject injury as a result of participation in a clinical trial that are otherwise not covered by insurance. The insurance company interpreted this as a self-insurance policy primary to their own. The attached article summarizes Medicare’s interpretation of such informed consent language in the same way. All of this is related to what is promised to subjects regarding medical cost coverage while participating in a clinical trial in the informed consent and does not constitute a general policy for handling payment of complications due to procedures deemed “experimental” by insurance companies. It is possible that this author is mixing the two issues together.
-Patrick
I think you’re confusing what’s in an informed consent document regarding promises as to who will pay (in the case the sponsor has promised to pay for medical care related to complications insurers view that as a payment source that super cedes their coverage) vs. what insurers are obligated to pay (all miladies including if they arise from investigational care).
It appears that the party is over and 50% of American Voters are waking up to the fact, someone must pay for the new ObamaCare plan of providing something to people for free, and taxing the rich won’t make a dent in it.
The gov’t doesn’t get it, but business does, Barbara’s insurance company see’s it’s fiscal cliff with 20/20 vision and is adjusting its premiums accordingly.
It should be clear to everyone that regenerative medicine holds great promise for society, but is a threat to big pharma at the moment. I suspect the shift in thinking will change over time as most controversial issues do.
God Bless America!
The fine is not “one time.” Business gets to keep paying fines until it becomes better to pay for insurance. Insurance laws including fines are written by insurance companies, the only business guaranteed a profit. It’s the law.
It is in the best interest of everyone that reimbursement issues be addressed.
Paul – I just read this article. http://news.yahoo.com/cost-becomes-bigger-treating-heart-disease-191213286–finance.html “Cost Becomes Bigger Question in Treating Heart Disease”. I’ve already seen with my own insurance policy that not only did my premium go up $900 a month and my deductible increased as well as co-pays, but some treatments and procedures are no longer being covered. I think health care as we know it in the past, will no longer exist under ObamaCare. Rising costs are all the more reasons to fast track experimental stem cell therapy which has the promise of possibly regenerating and repairing the body thus restoring health, not just treating the symptoms.
Also keep in mind that it makes more sense for *everyone* to pay the fine and to pay insurance premiums only after getting sick since insurance companies won’t be able to deny patients for pre-existing conditions.
That’s interesting! I have never heard of an insurance company deny anything because the care delivered, that caused complications was, “investigational.” If this is the case, then every time a doctor prescribed an FDA approved medication off label and it caused complications, the patient would be on the hook??? Do you know if ALL patients entering an investigational study are warned about this? What specific policy language from which insurers are you referring to? Good to think about!
Since I posted my last comment, I talked to a few personal friends of mine, who have been out of the country for treatment (MS) . Initially their treating physician in Dallas kicked them out of his practice for taking treatment into their own hands. This same doctor, now, has allowed ALL of the patients back, as he has seen too many improvements with these patients to ignore. None of them have had ANY issues with insurance covering, and it is a known fact that they have had treatment in another country. Unlicensed in our country yes, but NOT unlicensed in the treating country. I’m also contact with a large number of stem cell patients via FB. Once again nobody has ever had this happen. There are always exceptions to every rule, but as you can speak for the scientific community, I can speak for the MS patient community and say “I’ve never come across this in the 8 yrs. I’ve been looking into adult stem cell therapy. I thought this warranted a follow up comment to my comment! 🙂
Paul – Can you provide readers with specifics on this? What insurers have stated this and how does the language read? Would this mean any time a doctor prescribed an FDA approved medication off label and there were complications, that the patient would not be covered? Also, how does anyone know when a patient has stem cell therapy? I don’t recall ever getting a brand put on me or marked in any way to indicate I’ve had treatment. Patients already fail to disclose many things such as smoking habits, dietary habits, etc. I don’t see them rushing to a doctor declaring they had an experimental treatment of any kind if they are aware they could be denied coverage especially when the treatment may have had little to do with whatever problem they might be seeking treatment for. How could anyone predict down the road if someone will get cancer and if they do, why they got it? I think this is a real stretch to say a patient could be denied coverage because he had stem cell treatment years before. Smokers aren’t denied. Those that work in risky industries aren’t denied. I think this whole idea is grasping at straws and that insurance companies and doctors will find that patients will not be forthcoming with any information if the industry turns to such tactics to deny coverage.
The IRS also has allowed medical treatment expenses offshore to be legitimate deductions which is a plus for patients.
I am not convinced that the ObamaCare tax will help health care in any way if doctors decide to stop accepting certain patients and a physician shortage becomes a reality. Add that to the employers who are going to pay the fine and we will probably end up with a worse problem than what we started with.
I can’t provide specifics due to confidentiality.
As to how anyone would know if you got a stem cell treatment that’s a good point, but if one has an acute reaction to a treatment such as sepsis or autoimmune reaction I would assume the admitting MD at the hospital would ask for a history….I suppose the patient could lie by omission.
Paul, please comment on the following recent talk about employers dropping insurance because of the anticipated premium increase of ~15-20% and just paining the less expensive fine to the US Govt.
Example: If an employer does not offer health insurance, they will pay a $2,000 fine for each employee over 30 employees. So if you have 100 employees, your fine will be $140,000. Which is more expensive – paying for insurance for 100 employees or paying a $140,000 fine? According to Kaiser Family Foundation, the average premium for employer based coverage is $5,429 for a single person and the employer pays $4,508 of that premium. The insurance by far is more expensive than the fine.
Interesting math.