Insurance Denials for Osteocel

Osteocel is a cell based substitute utilizing mesenchymal stem cell therapy. Insurance companies are denying coverage for cell based substitutes stating they are not covered due to experimental/investigational and not widely used and generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature in the English language.

Are these denials worth appealing?

If so, what documentation are you supplying the insurance company? Are you winning?

Comments

  • If the specific insurance company has a policy that states they consider this experimental/investigational, then an appeal is not going to be successful. However, if their policy states "generally accepted for the proposed use as reported in nationally recognized peer-reviewed medical literature" then you could appeal with the support that would invoke this coverage clause.

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