Ask Dr. C: Episode 9-Imaging Guidance and Insurance Coverage
It’s ask Dr. C time again! Here are our questions for today:
When getting stem cells and PRP, is it necessary to use the guidance system or can the Doctor simply look at MRI and use it to inject?
This is a great question as it gets to one of the points that I’ve been discussing for many years. Imaging guidance is absolutely required to perform stem cell procedures correctly and with the highest chance of success. So what does that mean exactly?
Imaging guidance is like driving your car to a specific destination. Now imagine that someone painted your front windshield and side windows black and asked you to drive to that same destination? Could you get there? Unlikely. That’s what trying to guide a needle to a specific site is like without imaging guidance. Would it be easier if you had a map and a blacked-out windshield? Nope.
In this analogy, the ability to see where you’re going is the clear windshield, which represents imaging guidance. The blind injection off an MRI without imaging guidance is the map with your windshield painted black. So no, having an MRI and no imaging guidance wouldn’t help to get the cells into the right place.
Let me give you another example. To help heal the ACL ligament, you must inject stem cells exactly into the ligament. Even with an MRI, without imaging guidance, what’s the likelihood that the doctor will be inside the ligament when the stem cells are injected? 1 in 10 or less. With imaging guidance (in this case fluoroscopy) what’s the chance that the doctor will be in the ACL? If he or she is properly trained, 100%
Request a Regenexx AppointmentAre you guys actively pursing insurance companies to be a part of your network. I have wanted to go to you again, but unfortunately my United Healthcare insurance does not cover your services.
Regenexx is the only provider network offering orthobiologics like PRP and stem cells that has legitimate insurance coverage tied to various employers. We have been able to do this by having:
- A national provider network with very strict education requirements for doctors
- Standardized high-quality, image-guided procedures throughout the network
- Standardized processing of patient samples and treatment protocols
- Published research on exactly what we do
- A registry going back 15-years tracking patients
These contracts are with specific employers. We have about 7-8 million people covered now, but that’s just a drop in the national bucket. We will continue to expand that coverage and have been speaking with various insurance companies as well.
In the meantime, does any stem cell provider or solution have insurance coverage? NO! Why then do you hear from some clinics that they can get insurance companies and Medicare to cover amniotic or umbilical cord “stem cells”? That’s a billing scam that’s tricking these companies into inappropriately paying for something that they don’t actually cover. What will happen when they realize that they paid for something they shouldn’t? A clawback, which means the doctor and then you will be required to pay for this expensive procedure. To learn more, follow the link above or watch my video:
So while we may not yet have you covered, we’re working on it. If you want to check to see if your employer has decided to cover Regenexx, click here. In the meantime, don’t fall for Medicare or insurance billing scams where you will be in the middle of billing fraud and have to pay a bunch of money back!
Thanks for giving me great questions. I have some more good ones picked out to highlight this week!
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Dear Sir,
is it possible to get PRP and flu vaccination at the same day? Or is it better to do it a few day or a week later?
Thank you for your help.
Best wishes
I think getting them the same day would be fine.
Is Tri Care for Life [retired military] responded positively to your inputs? Are they willing to cover stem cell procedures for knees? The Air Force removed my minisus decades ago when I was on active duty.
Tricare covers PRP on a case by case basis, but not stem cells.
Hi Dr. C. I have been keeping Regenexx in mind for a number of years in relation to my OA of both knees. Well that day has come! I have been talking with Melanie in San Rafael and am starting the process. I have an insurance question. 1st of all I need to say that I am very familiar with the penalties of defrauding Medicare. I just retired from the US Dept. of Justice in DC and worked on a Medicare Fraud Taskforce; we put a lot of Dr.’s, Pharmacists and scam artists is Federal Prison for a long time! Are you working on getting Medicare approval for the SD procedure? Can I help? What is MACI (autologous cultured chrondoycite on porcine collagen membrane)? Have you looked into that. Can you please guide me to the latest research paper submitted re Knee OA stem cell w/results. Thanks!!! Bob
It will be a while before legitimate Medicare coverage ensues for Bone Marrow Concentrate. MACI is used to treat small holes in cartilage, so it’s not appropriate for more generalized arthritis.
Where in the Houston, Tx. area can I get prp injections?
Please see the Find a Clinic link above.
Forget insurance coverage. If you are truly suffering cronic pain as I was, the cost of the treatment is a drop in a bucket. I had both knees treated in 2017 and now after injuring myself again will retreat next month. It’s impossible to put a price on pain free after suffering 20 years.