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?
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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.