Exhale

The official blog of the Lung Institute.

Insurance Companies: Will They Cover Cellular Therapy for COPD?

9 Nov 2017
| Under Medical, Resources | Posted by | 3 Comments
Why_Doesnt_Insurance_Cover_Treatment

You have a lung disease and you have exhausted all the options your doctor has recommended. You’ve tried inhalers, nebulizers, corticosteroids and other treatments. The drugs provide relief, albeit temporarily, but over time the drugs don’t work as well and the disease keeps progressing.

You’ve heard about the Lung Institute and its remarkable cellular therapy where 84 percent of patients with COPD report an improved quality of life within three months of treatment. You like the fact it addresses disease progression (while drugs only treat symptoms), you like the simplicity of the treatments (2 days/outpatient), and you really like the chance to get your life back.

So, what’s the problem? The problem is cellular therapys not used in conjunction with certain medical indications are generally not covered by insurance companies. Typically, insurance companies consider the treatment “experimental” and therefore an elective.

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

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

A recent article in U.S. News & World Report quoted the director of the regenerative medicine program at the respected Mayo Clinic as saying cells, “teach the body to heal from within.”

But, for now, patients with a lung disease will have to heal without, without insurance coverage that is, for cellular therapys.

The distance between discovery of a new treatment and being fully covered by HMOs and other insurers can be vast. While the benefits of an emerging treatment may seem apparent, often, the delay between widespread application and coverage can simply be time.

How Do Emerging Treatments Get Covered?

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.Cellular treatments for bone marrow transplants have been available since the 1970s, and research continues to develop and show that cells can also address other diseases.

The field of cellular therapy has led to advancements in treating multiple sclerosis, heart disease, blindness, rheumatoid arthritis and even baldness.  As each new application of a new drug or treatment is discovered, it begins its own multi-year, unique development process that goes:

  • from clinical trials
  • to FDA approval and widespread use
  • to American Medical Association coding
  • to coverage from leading insurers like Medicare and Medicaid
  • to general acceptance by most other insurers.

What This Means for the Future

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. Each 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.

The Lung Institute is currently involved in two clinical studies. To find the current studies involving the Lung Institute, go to clinicaltrials.gov. In the “Other Terms” box type in LI-002 or LI-001 and click on “Search all studies,” for the two current studies. Results are posted for study LI-001.

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 (800) 729-3065 today to find out if you qualify for cellular therapy.

The Lung Institute supports National COPD Awareness Month in November sponsored by the US COPD Coalition. November 15 is designated as World COPD Awareness Day.

* 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.

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.

Each patient is different. Results may vary.