When you hear the word ‘experimental’ what do you think of? Do science labs and test tubes pop into your mind? Well, when an insurance carrier sees the word ‘experimental’ written in code on your submitted claim, they immediately think, ‘not medically necessary’.
Here’s what you need to know when it comes to experimental procedures & your insurance:
- When your insurance states that your experimental procedure is not ‘medically necessary’ what they mean is that there is no evidence-based outcomes to support that the experimental treatment plan will be successful.
- For this reason, most insurance contracts exclude – do not cover – experimental services or experimental procedures.
- If you decide that the experimental procedure is the right choice of treatment for you, you need to be upfront with your doctor and ask what the out-of-pocket cost is going to be. Ask lots of questions so you are prepared!
Knowing the facts and being upfront about your expectations is where you find your peace when it comes to experimental procedures & your insurance.
If you need further guidance on experimental procedures & your insurance, or you would like one of our agents to review your employee benefits group plan, give Clevenger Insurance a call today at 574-267-2181.