Things you can do to get your health insurance to cover a clinical trial

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Clinical Trials and Insurance Coverage

Posted: 05/08/2009

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Clinical Trials and Insurance Coverage

Things you can do ...

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How health insurers decide to cover clinical trial costs

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Coverage of Clinical Trial Costs

Things you can do to get your health insurance to cover a clinical trial

There are several steps you can follow to deal with insurance coverage

issues when deciding to enter a

<http://www.cancer.gov/dictionary/db_alpha.aspx?expand=c#clinical trial>

clinical trial. Here are some things to try:

* Work closely with your doctor. Ask your doctor if there is

someone on his or her staff who can help with health insurance issues. This

person might be a financial counselor or research coordinator. Or, this

person might work in the hospital's patient finance department.

* Work closely with the research coordinator or research

nurse. Ask the research coordinator or nurse if other patients have had

problems getting their health insurance companies to cover their costs. If

so, you might ask the research coordinator or nurse for help in sending

information to your health insurance company that explains why this clinical

trial would be appropriate for you. This package might include:

* Medical journal articles that show patient benefits

from the treatment that is being tested

* A letter of medical necessity

* Letters from researchers that explain the clinical

trial

* Support letters from

<http://www.cancer.gov/dictionary/db_alpha.aspx?expand=p#patient advocate>

patient advocacy groups.

Helpful Hint: Be sure to keep your own copy of any materials that are sent

to your health insurance company.

* Work with your health insurance company. If your doctor

does not have a staff person to help with insurance issues, call the

customer service number on the back of your health insurance card.

* Ask to speak to the benefit plan department.

* Ask if your health insurance plan covers routine

patient care in clinical trial.

* If your health insurance covers routine patient

care in a clinical trial, ask if an authorization is required. An

authorization means the health insurance company will review information

about the clinical trial before deciding to cover it.

* If your health insurance company requires an

authorization, ask the following:

* What information do you need to provide?

Examples might include copies of your medical records, a letter from your

doctor, and a copy of the consent form for the trial.

* The name and contact information of the

person you are talking to.

* If an authorization is not required, you don't have

to do anything else. But, it is a good idea to request a letter from your

health insurance company that states an authorization is not needed for you

to take part in a clinical trial.

Helpful Hint: Every time you call your health insurance company, make a note

of who you are speaking with, the date, and time.

* Understand the costs related to the trial. Ask your doctor

or the trial's contact person about the costs that must be covered by you or

your health insurance.

* Work closely with your employer's benefits manager. This

person may be able to help you work with your health insurance company.

* Give your health insurance company a deadline. Ask the

hospital or cancer center to set a target date for when you should start

treatment. This can help to ensure that coverage decisions are made

promptly.

What you can do if your claim is denied after you begin taking part in a

trial

If your claim is denied, contact the research coordinator or nurse for the

clinical trial. He or she will know how to appeal your health insurance

company's decision. If your treatment in the trial is taking place in your

doctor's office, ask the office billing manager for help.

You can also read your health insurance policy to find out what steps you

can follow to make an appeal. Ask your doctor to help you. It might help if

he or she contacts the medical director of your health plan.

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