If you are thinking about participating in a clinical trial, you may be wondering if your health insurance will cover the cost of your care. Not necessarily.
While the cost of the treatment itself is often covered by the manufacturer, there are other expenses that may be associated with the trial, such as doctor visits, hospitalization costs, and extra lab testing. If the trial is testing a particular medical device, for example, the manufacturer may cover the device itself but not the surgery required to implant it. You would then be responsible for finding a way to cover that expense.
Health plans deny coverage for clinical trials for a variety of reasons. Some feel that the treatment offered is "experimental" and by definition is not proven to be beneficial to patients. Some will allow coverage only if there is absolutely no other treatment available. Some require that the trial be cost-effective, or meet certain criteria.
Fortunately, 25 states have passed laws requiring insurers to cover the care associated with clinical trials. Medicare also offers clinical trial coverage.
Before you enroll in a clinical trial, check and double check with your insurer to make sure that your expenses will be covered. If it is not covered, you may be able to enlist the help of the clinical trial sponsor, who has an interest in enrolling qualified patients. You can also follow the claims dispute procedure for your state.
