Platelet-rich plasma (PRP) therapy is becoming increasingly popular for various treatments, from sports injuries to skin rejuvenation and hair loss.
However, as more people turn to this innovative treatment, a common question arises: Does insurance cover PRP therapy?
Many have heard rumors that it’s entirely out-of-pocket, while others claim some insurance companies might offer partial coverage. Let’s break down the facts, debunk some myths, and explore the current landscape of PRP coverage.
Why Don’t Most Insurance Companies Cover PRP or Stem Cell Injections?
Despite its growing popularity and potential benefits, most insurance companies must cover the treatment. The primary reason is that PRP therapy is often considered an elective, experimental, or investigational procedure.
Many insurers view PRP as lacking enough solid, large-scale clinical evidence to guarantee its effectiveness, especially compared to more traditional treatments like surgery or physical therapy.
Insurance companies typically seek FDA approval or conclusive, long-term studies before agreeing to cover a treatment. While PRP has shown promise, particularly in treating joint pain, tendon injuries, and hair restoration, it has yet to reach the threshold of medical consensus that it needs to be widely covered by insurers.
Additionally, PRP’s use in aesthetic treatments, such as facials and skin rejuvenation, falls under the “cosmetic” category, which rarely, if ever, sees insurance coverage. Because many insurance companies consider cosmetic treatments non-essential, they are left to the patient’s discretion and wallet.
How To Get PRP Injection Insurance Coverage
That said, not all hope is lost. In some cases, you might still be able to get PRP therapy covered by insurance, but it usually requires persistence and a strategic approach.
Here are a few steps you can take to potentially increase your chances of getting coverage:
Talk to Your Healthcare Provider:
Start by having a candid conversation with your healthcare provider.
If PRP is being recommended for a medical condition rather than an elective or cosmetic reason, your doctor may be able to write a letter of medical necessity.
This letter outlines why PRP is essential to your treatment plan and why traditional methods are unsuitable.
- Document Your Treatment Journey: Document your history if you’ve tried other treatments. Insurance companies are more likely to cover PRP if you’ve already attempted other therapies (such as medications, physical therapy, or surgery) without success.
- Pre-Authorization: Some insurance plans may allow for pre-authorization. Your doctor will submit your case to the insurance company for approval before treatment begins. It’s not guaranteed, but it might improve your chances of getting partial or complete coverage.
- Check for Employer-Specific Coverage: Some companies or industries offer specialized healthcare plans that include alternative therapies like PRP. Check with your employer’s HR department or benefits coordinator if your coverage includes PRP treatments.
What Insurance Companies Cover PRP Therapy?
Though PRP therapy is not widely covered, a few insurance companies may offer limited coverage, especially for medically necessary treatments. Here’s a breakdown of what significant providers are offering when it comes to PRP:
Aetna
Aetna does not generally cover PRP therapy, citing it as experimental or investigational. However, there are rare exceptions where PRP might be covered for specific conditions like osteoarthritis or tendinitis, provided the treatment is deemed medically necessary.
United Healthcare
United Healthcare also considers PRP an investigational treatment. As of now, the company does not cover it under most plans. However, similar to Aetna, they may review cases individually if a medical necessity is demonstrated.
Tricare
Tricare, the health insurance provider for military personnel and their families, generally excludes PRP therapy from coverage.
However, as with other insurance companies, medical necessity may influence exceptions for active duty members with specific conditions that could benefit from PRP.
Blue Cross Blue Shield
BCBS typically does not cover PRP, classifying it as experimental. However, state-by-state coverage might vary, and it’s worth checking with your local BCBS provider to see if any exceptions apply in your area.
In some cases, BCBS has been known to offer partial reimbursement for PRP when prescribed for orthopedic issues like joint injuries.
Medicare
Medicare doesn’t currently cover PRP therapy and will not reimburse for it since it is classified as an investigational treatment. However, partial coverage might be available in limited cases where PRP is part of a broader medical procedure.
Cigna
Cigna does not cover PRP therapy for most applications, categorizing it as experimental or unproven. Like others, they may allow exceptions based on specific medical needs, but this is rare and often requires significant documentation.
The Cost of PRP Therapy
Patients often have to pay out of pocket because PRP is not widely covered by insurance. On average, PRP injections can range from $500 to $2,500 per session, depending on the treatment area, the number of injections, and the provider’s expertise.
Some clinics offer payment plans or discounts for multiple sessions, which can ease the financial burden for those needing long-term treatments.
Aesthetic procedures like PRP facials or hair restoration tend to be more expensive. In contrast, medical treatments for injuries or chronic pain may be more affordable.
Why PRP Will Soon Be a Widely Covered Treatment
The landscape for PRP therapy coverage is evolving. With more clinical studies underway and an increasing demand from patients and doctors alike, PRP could soon become a mainstream, insured treatment.
In recent years, smaller-scale studies have shown PRP’s potential benefits in treating joint injuries, osteoarthritis, and tendon repair, which are slowly gaining attention from insurers.
As more research is published and PRP demonstrates positive outcomes, insurance companies will likely reevaluate their stance. Some private insurers are already testing limited PRP coverage under particular medical conditions.
Takeaways
PRP therapy is still considered an out-of-pocket expense for most patients. However, that means you still need more luck regarding insurance coverage.
Exploring options like pre-authorization, working with your doctor to demonstrate medical necessity, and checking employer-specific plans can all increase your chances of getting coverage.
In the coming years, we may see a shift in how insurers view PRP therapy, mainly as more research solidifies its benefits for various conditions. If you’re considering PRP therapy and want to know more about your options, contact our team to schedule a consultation and explore how PRP might work for you—whether insurance covers it or not.
