Stem Cell Therapy Insurance Denial

Stem cell therapy, also known as regenerative medicine, promotes the repair response of injured, dysfunctional, or diseased tissues by using stem cells or stem cell derivatives. At some point, stem cells will likely be used in organ transplantation rather than donor organs. A doctor may recommend stem cell therapy as a treatment for a serious disease. Receiving a stem cell therapy insurance denial can be disheartening and discouraging, to say the least.

If you have experienced a stem cell therapy insurance denial, you need the assistance of an experienced, knowledgeable insurance denial attorney like attorney Scott Glovsky. When you choose the Law Offices of Scott Glovsky, you can expect a team who will fight aggressively on your behalf to get you the medical treatment you need and deserve.

Page Contents:

• What is Stem Cell Therapy?
• What Conditions Can Be Treated with Stem Cell Therapy
• Why Would an Insurer Deny Stem Cell Therapy?
• What Can You Do if Your Treatment is Denied?
• What Insurers Are Most Likely to Deny Stem Cell Therapy?
• How the Law Offices of Scott Glovsky Can Help You

What is Stem Cell Therapy?

Stem cells have two important properties. First, they are able to self-renew, making more cells like themselves, and second, they can become other cells that do different things. Stem cells are found in virtually every bodily tissue and are used by the body to repair itself following an injury. As an example, hematopoietic stem cells reside in the bone marrow and can produce every cell that functions in the blood. A stem cell can become a bone cell, a heart muscle cell, a brain cell, or other types of cells.

Researchers can grow stem cells in a laboratory, manipulating them to specialize into specific types of cells. Those specialized cells are then implanted into a person; if a person has heart disease, stem cells are injected into the heart muscle to help repair an injured heart. Doctors routinely perform stem cell transplants known as bone marrow transplants. Once introduced into the bone marrow, these cells repair and replace cells damaged by cancer or by chemotherapy or other treatments to cure cancer. A potential downside to stem cell therapy is that embryonic stem cells can trigger an immune response in the body, attacking the stem cells because they are seen as foreign invaders.

What Conditions Can Be Treated with Stem Cell Therapy

Some potential conditions that can be treated with stem cell therapy include:

• Some types of cancer
• Bone cancer
• Hodgkin’s disease
• Anemia
• Autoimmune upsets
• Multiple sclerosis
• Type 1 diabetes
• Rheumatoid arthritis
• Parkinson’s disease
• Heart failure
• Amyotrophic lateral sclerosis
• Osteoarthritis
• Liver disease
• Leukemia
• Kidney disease
• Alzheimer’s
• Spinal cord injury
• Cerebral palsy
• Muscular dystrophy

Why Would an Insurer Deny Stem Cell Therapy?

Sometimes, a stem cell therapy insurance denial is due to something relatively simple that can be fixed, and then the claim can be resubmitted. An error, omission, or failure to provide sufficient information and out-of-network treatments can lead to a denial. Most often, however, a treatment denial is about money, even when cloaked in such terms as “not medically necessary,” “investigational,” or “experimental.”

The cost of stem cell therapy can range from $5,000 to $50,000, depending on the type of stem cells administered, the number and quality of cells, the source of the stem cells, and even the location of the laboratory. A single stem cell injection can cost approximately $4,000. In 2023, the use of an expanded stem cell product cost between $15,000 and $30,000. Orthopedic stem cell treatments may be a bit lower, averaging between $5,000 and $8,000, and can be used for arthritis, tendonitis, osteoarthritis in the knee, and cartilage defects.

What Can You Do if Your Treatment is Denied?

If you receive a denial of your stem cell therapy treatment, you have options. You can file an internal appeal, asking your insurer to reconsider its original denial. If you submit an internal appeal, be aware of specific time limits and consider attaching a letter from your doctor that clearly details why you need stem cell therapy and how it will improve your health. If your internal appeal is denied, you can file an external appeal. This is an appeal with a neutral third party; the decision of this third party is binding on the insurer. For this reason, we suggest you speak with an experienced health insurance denial attorney before you file.

What Insurers Are Most Likely to Deny Stem Cell Therapy?

Although some insurance companies may cover specific stem cell therapies like bone marrow transplants, other stem cell therapies are often seen as experimental, so they may not be covered by some insurers. Any insurance company can potentially deny a treatment, but the following California insurers may be more likely to do so:

• Anthem Blue Cross
• Blue Shield
• HealthNet
• Kaiser
• Cigna
• Aetna
• Medi-Cal Managed Care Plans
• Others

How the Law Offices of Scott Glovsky Can Help You

If you have received a stem cell therapy insurance denial, do not despair. Attorney Scott Glovsky and his experienced legal team fight for justice for their clients. In some cases, this could be your last chance to get the justice you need and deserve. The Law Offices of Scott Glovsky takes that responsibility very seriously. Contact the Law Offices of Scott Glovsky today.