Is Platelet Rich Plasma Therapy Insurance-Covered?

Are you wondering which insurance companies cover PRP therapy? Well, to start, let us have a little look at the background of PRP (platelet-rich plasma). Honestly, this is a pretty controversial treatment. Yet, it is slowly becoming increasingly popular in the fields of dermatology and science.

At the moment, the Food and Drug Administration (FDA) has declared the use of PRP only for bone graft treatments. But, doctors use this treatment to treat a variety of other issues as well. These are some of the other reasons for which the use of PRP therapy gets done:

  • Promote hair growth
  • Aid in the muscle healing process
  • Treat the symptoms of Arthritis

Here we will be discussing all the necessary information you need to know regarding this topic. We’ll also answer your question regarding insurance companies that cover PRP therapy in a way that you will understand. So, please read this article until the end to find out everything you need to know.

What Is PRP Therapy?

This therapy treatment requires the doctor to prepare a concentration of platelets using the patient’s blood. Afterward, its injected back into the patient to quicken the healing of a specific part of the body.

What Is Platelet-rich Plasma (PRP)?

Out of the four main components of our blood, plasma and platelets are the ones that we will discuss currently. That’s because PRP platelet-rich plasma consists of two elements.

First is plasma which is the liquid portion of our blood. Second is platelets which are pieces of large cells that aid in forming blood clots to slow down or stop bleeding.

It’s commonly known that platelets play a vital role; when it comes to healing our body. However, apart from that, they serve another significant function. They are growth reservoirs, and that means they; hold the ability to do the following:

  • Stimulate tissue regeneration
  • Trigger cell reproduction

Essentially, platelet-rich plasma is our blood but with a higher percentage of platelets in it to accelerate healing.

How Is A PRP Injection Made?

The patient’s blood sample is collected by the clinician. It is then sealed in a container and placed in a device called a centrifuge. This device then spins at a very high speed.

Resultantly the components of blood are separated from the platelets. After being separated, the platelets get gathered with the plasma; this is called the PRP injection.

How is the injection used?

When the injection is ready, the doctor jabs it onto the patient’s targeted area, for instance, a damaged muscle. Depending on the situation, sometimes an ultrasound gets used while injecting to guide the injection.

Uses Of The PRP Treatment

PRP injections get used for a variety of reasons. The reason can be severe, for instance, to get rid of musculoskeletal pain. Or it can be simple, like getting it to stimulate some hair growth. Listed below are some of the common reasons why the PRP treatment gets done:

1.To treat a fractured bone

The high quantity of plasma in the PRP injection; aids in regenerating the bone. Thus, resulting in a quick recovery.

Treating osteoarthritis

Studies show that PRP injections can help treat osteoarthritis pain. Because with their help, the joints adjust, and this results in the inflammation getting reduced.

3. Healing damaged tissues

Platelets hold the ability to heal damaged tissues such as ligaments and tendons.

How Costly Is The PRP Treatment?

The cost of this treatment might vary for multiple reasons. But as for now, the price of a single PRP injection is anywhere between $800 and $2,000. As we mentioned before, the cost of this treatment varies depending on some factors. For example,

  • The amount of experience and certification that your PRP specialist owns. The body area that is being treated.
  • The quality of the PRP system used for the process.

How Does PRP Work?

Platelet-rich plasma (PRP) can speed up the body’s natural healing process due to the fact that human plasma contains several chemical substances that help injured tissue rebuild and repair itself.

It’s already quite common for practitioners to use PRP therapy on various soft-tissue injuries like damaged Achilles tendons, torn rotator cuffs, and more.

Additionally, active people who enjoy golfing and tennis are turning to PRP for help with common ailments like golf/tennis elbow, tendinosis, and chronic tendinitis. One of the primary advantages of the therapy is its ability to reduce or even eliminate the need for strong medications like opioids and anti-inflammatory drugs.

Another advantage of PRP therapy is the lack of side effects. Because the treatment uses the patient’s own blood, there’s no risk of infection or rejection.

The Cost of PRP Therapy

Naturally, costs vary greatly depending on which clinic a person visits and which practitioner they see. In general, people should anticipate paying between $800 and $1,000 for their initial PRP injection.

Following that, prices are even more difficult to predict because some people only require a few injections while others require many more.

A typical PRP therapy with up to 8 injections, on the other hand, may cost between $,5000 and $8,000. The treatment is usually continued until the patient has recovered completely.

Insurance and Reimbursement for PRP

PRP treatment and therapy regimens are, without a doubt, on the pricey side of things. The majority of insurance companies do not cover it at all. PRP is considered a “pay for service” treatment by clinics that offer it.

The main reason why insurance companies are hesitant to pay the treatment, at least for the time being, is that there hasn’t been enough testing. PRP is still in the experimental stages of proving its efficacy, according to medical reimbursement experts.

As things stand, anyone who chooses PRP treatment will be responsible for the entire cost. Until the additional study is done and PRP receives the scientific underpinning it needs to be fully reimbursed by insurance, it will likely remain a niche treatment.

How To Get PRP Injection Insurance Coverage

Many researchers in the field of PRP believe there is deep resistance in the medical/surgical community to the treatment. It’s possible that PRP treatments could supplant a large number of surgical procedures.

Medical professionals who believe in PRP and have already witnessed its effectiveness first-hand are working hard to get PRP covered by insurance providers.

This is a difficult task, to say the least. Researchers and PRP advocates are using a four-pronged approach to gain wider acceptance for the treatment.

PRP advocates are currently working to:

  • Compile study findings that demonstrate the efficacy of PRP.
  • Gather massive amounts of data from medical experts who administer PRP treatments on a daily basis in order to better understand how beneficial it can be to those who utilise it.
  • Encourage colleges to conduct more PRP research.
  • Create extensive cost comparison charts that demonstrate how much less expensive PRP is in comparison to the surgical treatments it can replace.

Perhaps if insurance providers saw how much they could save by preventing some types of surgery and also saw how effective PRP is for those who use it, insurers might slowly begin to realize that covering PRP would be a good idea.

Right now, for example, most forms of medical insurance fully cover injections of corticosteroids. In fact, this form of treatment is less effective than PRP and has many potentially dangerous side effects. Convincing the insurance industry that PRP is superior to corticosteroid treatment is a promising avenue for advocates.

Even though PRP therapy is a success for many types of pain and injury rehabilitation, too many prospective patients are unable to afford the injections. More research is needed to bring insurers on board and to convince the medical community that PRP is indeed effective and safe.

Is The Therapy Covered By Insurance Companies?

Is health insurance going to cover therapy? Knowing so much about PRP therapy, this question must have crossed your mind: which insurance companies cover PRP therapy? The majority of the time, insurance will not cover the PRP treatment.

This is due to the fact that insurance companies consider this treatment to be optional. Some insurance companies, however, will pay this treatment for you if certain conditions and restrictions are met. The following are some of them:

1. Wellcare

Wellcare health insurance customers can get their PRP covered if they sign up for a study as well.

2. Tricare

This company covers for their policyholders’ PRP treatment only under a certain condition. And, that is if the patient is suffering from a tennis elbow or chronic knee osteoarthritis.

3. Medicare

Medicare only covers the PRP treatment for its patients who are dealing with chronic non-healing diabetes, pressure, and venous wounds. The patients are also required to be enrolled in a clinical research study.

How Can You Get It Covered?

Try convincing your insurance company that this is not an experimental treatment. Use studies and certified articles to support your statement. Try reaching out to a professional who has more knowledge on this matter. This way you’ll be able to learn some more facts to support your argument.

What’s the Future of PRP?

It’s probable that insurance companies will pay PRP in the near future, especially as an alternative to hyaluronic acid and corticosteroids injections. Many athletes who can afford to pay for PRP treatments out of pocket have had great success with it.

Clinical trials in China have recently shown considerable potential. PRP clearly outperformed corticosteroids, ozone, hyaluronic acid, and other kinds of therapy for osteoarthritis of the knee in more than a dozen trials with over 1,400 participants.

Two other large investigations, one of which included over 1,000 individuals in China, confirmed PRP’s clear advantage over less effective osteoarthritis treatments.

In the United States, hyaluronic acid and corticosteroids injections are prevalent. Unfortunately, these treatments frequently result in tissue degradation and the need for pricey surgery. Corticosteroids, in fact, frequently cause osteoporosis.

PRP is clearly the superior treatment when compared to the more typical treatments used, as evidenced by extensive study and testing. PRP also has no negative effects, can be used to avoid surgery, and has been established in clinical trials.

The amount of money saved by the insurance industry by avoiding unneeded knee surgery is projected to be in the range of $87 billion a year at the very least. Unfortunately, when people learn about how beneficial PRP treatment is, they often decide against it based simply on the cost.

By 2016, the entire PRP medical market reached the $120 million mark. That number is significant because it represents how much people paid out of their own pockets, with absolutely no insurance reimbursement.

Hopefully, if PRP procedures are standardized and more research is done, insurance reimbursement will become widespread and more people can take advantage of the healing powers of their own blood platelets.

Is PRP Therapy Right For You?

Is PRP Therapy right for you? If you have considered taking advantage of the rapid healing of PRP treatment don’t know how to proceed, contact us at the number below or fill out the brief form and one of our professional staff members will contact you to answer any questions you have about PRP, how the treatment works, associated costs and how to pay for the treatment. Platelet-rich plasma therapy could be the answer to your physical challenge.

Conclusion

We hope this article was helpful in terms of answering all your questions. Now you have a clear idea of what insurance companies cover PRP therapy.

Also Read:

Leave a Reply

Your email address will not be published.