Is Platelet Rich Plasma Therapy Covered By Insurance?
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
Of course, there are large variations in cost depending on which clinic a person uses, and which practitioner they see. In general, people should expect to pay somewhere between $800 and $1,000 for the first injection of PRP. After that, costs are even harder to estimate because some patients need just a few injections and others need many more. However, a typical PRP treatment of up to 8 injections could cost between $,5000 and $8,000. The course of treatment is usually continued until the patient has fully healed.
Insurance and Reimbursement For PRP
It’s fair to say that PRP treatment and therapy regimens are on the expensive side of things. Most insurance providers do not cover it at all. Clinics that offer PRP consider it a “fee for service” type of treatment. The main reason insurance companies are reluctant, at the present time anyway, to cover the treatment is that there has not been enough testing. In the opinion of medical reimbursement experts, PRP is still in the experimental stages of establishing its efficacy.
As things stand, anyone who opts for PRP treatment will have to pay the entire bill out of their pocket. Until more research can be done and PRP can gain the scientific backing needed for full insurance reimbursement, the therapy will likely remain a fee-for-service procedure.
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:
- Assemble research results that demonstrate the effectiveness of PRP
- Collate vast quantities of data from medical professionals who perform PRP treatments every day and understand how helpful it can be for those who use it
- Encourage universities to do more research on PRP
- Create detailed cost comparison charts that clearly show how much less costly PRP is than the surgical procedures it can replace.
Perhaps if insurance providers see how much they can save by preventing some types of surgery and also see 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.
What’s the Future of PRP?
It’s possible that in the near future insurance companies will offer coverage for PRP, especially as an alternative to injections of hyaluronic acid and corticosteroids. Many athletes, who can afford to pay out of pocket for PRP treatments, have already had much success with PRP.
Recent clinical studies in China have shown great promise. More than a dozen trials that included 1,400-plus subjects clearly demonstrated the superiority of PRP over corticosteroids, ozone, hyaluronic acid and other forms of treatment for osteoarthritis of the knee.
Two other major studies, one of which included more than 1,000 subjects in China, again showed the clear advantage that PRP has over less effective treatments for osteoarthritis.
Injections of hyaluronic acid and corticosteroids are common in the U.S. Unfortunately, those forms of treatment often lead to degeneration of tissue and the need for costly surgery. In fact, corticosteroids often lead to osteoporosis. It’s already clear, based on vast research and testing, that PRP is the superior treatment compared to the more common methods uses. Further, PRP has no side effects, has the potential to prevent surgery, and has proven itself in clinical trials.
The amount of money the insurance industry could save by preventing unnecessary knee surgery is estimated to be in the neighborhood of $87 billion per year at minimum. Unfortunately, when people seek PRP treatment after hearing about how effective it is, they often decide against it based solely on the cost factor.
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.
