Stem Cell Procedure Insurance Coverage?

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stem cell insurance coverage

Regenexx has always been different. One of the differences is that it's the first company on earth to begin getting insurance coverage for regenerative interventional orthopedics. Let me explain. 

The Last Decade Has Been a Mess for Healthcare Costs

Whatever your political bent or take of the Affordable Care Act, as a practicing physician on the ground, it's made a mess out of healthcare costs. While the good news is that there's coverage for preexisting conditions and more people insured, the bad news is that the structure of the law forced more consolidation of local healthcare monopolies. Basically, local hospitals have bought physician practices and with that increase in pricing power have upped prices, leaving insurers and self-insured companies in a death spiral of exploding costs.

A Key Cost Driver Is Orthopedics 

One of the most significant cost drivers in any healthcare plan is orthopedic surgery costs. In the past decade, as more and more surgeons own surgical centers in partnership with hospitals, the number of surgeries being performed has dramatically increased. Hence, if you're a company trying to control its healthcare costs, one area where you're getting hammered is orthopedics. 

The Lack of a Credible Gatekeeper

One of the problems with orthopedic surgery is that the fox guards the henhouse. Meaning that surgeons decide which procedures patients need and then through a myriad of conflicting financial interests benefit from the surgery. I've already discussed the ownership of surgery centers with hospitals. However, add to that ownership in or relationship with surgical hardware companies, and the incentives to operate mount. 

The problem for insurers has always been that simply installing a gatekeeper creates the prohibition effect. A gatekeeper is someone who decides whether the patient really needs the surgery. As Mark Twain once said…

"It is the prohibition that makes anything precious.”

So if a gatekeeper tells a patient that he or she doesn't need surgery, even if that's demonstrably true, human psychology will make that person believe that he or she needs the surgery even more. Hence, simply installing an administrative or physician gatekeeper in front of surgeons doesn't work to reduce surgery rates; it just makes patients angry. 

However, what if this problem was approached differently? Rather than prohibition, what if the gatekeeper offered a better way to treat the problem? Then there is no prohibition. 

Much of Invasive Orthopedic Surgery Doesn't Work

However, why would we want to replace orthopedic surgery? It works well, right? Wrong. As I have shown in prior posts, the efficacy of more and more surgeries is being called into question. However, what if we substituted interventional orthopedics? What's that? See my video below:

Regenexx has pioneered interventional orthopedics (IO); hence, it would make sense that it would be the first company to get insurance coverage by substituting this treatment approach for invasive surgery. However, how does the research supporting IO compare to surgical orthopedics? See my video below:

So the Regenexx plan uses a trained provider in interventional orthopedics to decide whether the patient needs surgery. If the patient can be helped without surgery, the IO provider offers a better way. 

Making Sure the Fox Doesn't Hire a Fox to Guard the Henhouse

You might ask yourself, why don't we have orthopedic practices offer these services? First, they don't have the expertise to perform these procedures. However, they could hire someone, right? The problem is, that is like the fox hiring another fox to guard the henhouse. Meaning, the surgical gatekeeper can't be beholden to the surgeon. He or she must be an independent entity that benefits from declining surgery rates is not financially hurt by same. 

The Success of the Regenexx Corporate Plan

The Regenexx corporate plan as described above (an IO gatekeeper who offers a better solution) was piloted several years back in Iowa. To hear about the success of that program, see our video below:

This year has been a breakout time for this program. We have signed on many insurance brokers and many new corporate clients. Some of these include the following:

  • Edison Health
  • ACAP
  • Holmes-Murphy
  • Essilor
  • Dean Foods
  • Meredith
  • HCR ManorCare
  • Promedica
  • Shamrock 
  • Samaritan Ministries
  • Viero Wireless

In addition, our Colorado HQ site will also soon be announcing a major municipality partner in the next month. So far, the program is approaching approximately 7 million covered lives with many more that will be added this year. These are patients who have full coverage for Regenexx procedures through their health insurance and who are incented to avoid invasive and often ineffective orthopedic surgery. 

The upshot? Turns out that substituting less invasive interventional orthopedics and orthobiologics can reduce invasive surgery rates and save companies money while delivering a better healthcare product to their employees. Only Regenexx, a group focused on reducing surgery rates, can pull this off, because only Regenexx has been collecting data on the efficacy of its procedures since 2005. 

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18 thoughts on “Stem Cell Procedure Insurance Coverage?

  1. Jackie

    Please tell me more, how are these cells collected, eventhough I am almost 70?

    1. Regenexx Team

      Hi Jackie,
      We use bone marrow stem cells, aspirated from the back of the hips of our patients, as they are the most effective for treating orthopedic injuries and arthritis. Except for severe hip arthritis, which is very different than arthritis in other joints, your age is not a factor. Please see: https://regenexx.com/blog/orthopedic-stem-cell-treatment/ and http://www.regenexx.com

  2. constance catron

    what is the status of covering Regenexx for rotator cuff treatment (medicare and tricare for life)

    1. Regenexx Team

      Hi Constance,
      At this point in time, neither Medicare, nor Tricare cover the procedures. They may cover the initial extensive exam, which given the lack accurate diagnosis today is very valuable. To see what may be covered in your case, please call 855 622 7838.

  3. Jeff Boyd

    Blue cross blue shield needs to start covering these injections; I want to avoid surgery.

  4. Ehsan gul

    Hi I wanted to ask for the hip stem cell therapy or injection and m looking for insurance cover my therapy

    1. Regenexx Team

      Hi Ehsan,
      We’re not aware of any Insurance that covers stem cell procedures in the UK. If you want to see if you would be a Candidate for Regenexx treatment for your hip without Insurance, please contact: https://www.algocells.com/?utm_source=regenexxreferral&utm_campaign=algocells

  5. Kevin platts

    I have to have both knees replacement done it’s bone on bone will this work for me what your saying

    1. Regenexx Team

      Hi Kevin,
      We treat severe kknee arthritis regularly. We’d need more information through the Candidacy review to evaluate any indiviual case. Please see: https://regenexx.com/blog/knee-arthritis-stem-cell-treatment/ and https://regenexx.com/blog/ironman-stem-cell-procedure/ To have us weigh in on your case please use the candidate form here: https://regenexx.com/conditions-treated/knee/

  6. Ashley Paige Reinhardt

    Do you guys take Insurance ?

    1. Regenexx Team

      Hi Ashley,
      Yes, approximately 7 million people have coverage for Regenexx procedures. Please see: https://regenexx.com/blog/stem-cell-procedure-insurance-coverage/ If you’re not covered by one of those plans and would like more information on how to get involved, please see: https://regenexxcorporate.com/ Insurance in general, will unfortunately, take longer. Thankfully though, the cost of these procedures are often about the same as the out of pocket costs for the surgeries they replace, with deductibles, co-pays, downtime, rehab, time missed from work. http://www.regenexx.com. is there a particular issue you’re looking into treatment for?

  7. Rosemary Hutcherson

    I am searching for options about what will be the best for me.
    I am having pain in my knees. It is causing my mobility to be limit.
    I am getting so any this or that. Please assist me in what will you subject.

    1. Regenexx Team

      Hi Rosemary,
      We treat knee pain regularly and have helped many thousands of patients avoid knee surgery. We’d need more information through the Candidacy process to advise you. To do that, please use the Candidate button here: https://regenexx.com/conditions-treated/knee/

  8. Rob Long

    What’s pathetic is that Insurance won’t pay because Pharma loses business. With Surgery – you get passed on to Pharma to “manage” your forever pain results from surgery.

    Insurance says: “A treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition is deemed not medically necessary”
    And the other thing they say: it’s also considered a “natural” treatment because it is not a medication and it does not require surgical intervention, therefore; insurance companies do not the treatments.

    Sounds like Pharma Sleeps with Health Insurance

  9. Mary

    Does commonground, optum rx cover this?

    1. Chris Centeno, MD Post author

      Not yet

  10. Robbie Bates

    I’ve been told I need total replacement surgery on both knees. I have BC/BS of Alabama. Please tell me there is a way for this to be covered so I don’t have to have major surgery on both of my knees!!!

    1. Chris Centeno, MD Post author

      This is not covered through BC/BS but is covered through various employers.

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