Does Insurance Cover PRP

Why PRP Is Not Covered By Insurance

Many people who would like to try PRP therapy are kept from doing so by the fact that it’s not covered by their insurance. Despite the fact that PRP therapy is considerably less expensive than most surgeries and is being publicized by professional athletes for helping them to heal faster, insurance companies define PRP as “experimental and investigational” and say it’s “unproven”.

Regardless of this position by the insurance companies, PRP is still getting a lot of attention. The World Anti-Doping Association removed PRP from its list of banned substances after it was determined that it did not enhance an athlete’s performance.  The NFL, MLB and the NBA have authorized the use of PRP in their respective sports with PRP being one of the first treatments available for injured athletes.

PRP has been used to treat a multitude of conditions with some astounding results. There have been countless testimonials from all the happy recipients of PRP that claim they were healed faster and feel so much better than they did before the treatment. But unfortunately, the treatment doesn’t always work for everyone or for every condition.  The fact is the effectiveness of PRP has not been established by medical science yet.

Any treatment that hasn’t been established by medical science can be labeled as “experimental and investigational” and therefore the insurance companies are not required to pay. However, while insurance companies are reluctant to pay for the treatment itself, they will normally pay for the procedural fee and the office visit. At least that’s something.

Why hasn’t PRP been established by medical science yet? Isn’t there overwhelming evidence to support the claims of PRP? Some will say yes, while others will say no. It’s all very confusing.

For one thing, PRP lacks a standardized and regulated preparation and procedure that can be readily repeated by everyone. Without precise guidelines established for the procedure, it’s up to the physician to determine the best course of treatment. Many doctors are providing PRP treatments because of the demand from their patients, but they’re not always keeping track of the exact preparation that they used. This makes it very difficult to evaluate the results and establish any solid data.

There have been several clinical trials of PRP to test its efficacy, but without a standard procedure that everyone can follow, the results are scattered.  While some of these studies showed PRP to be only as effective as a placebo, others showed PRP helping the body to speed the healing of injuries by several weeks.  Another study showed PRP to be totally ineffective, while additional studies clearly showed PRP strengthening and thickening ligaments and tendons as well as regenerating cartilage.

So who’s right? Which studies are accurate? How can there be so much variation in the results?

Most of the discrepancies have to do with the definition of PRP and the way that it’s prepared. At the moment, PRP is too general a term and seems to apply to every single solution made from blood.  The current definition of PRP is a measure of plasma with a platelet count greater than the baseline of whole blood. However, all platelet-rich plasma is not created equal. Some concentrations of PRP may contain twice the number of platelets found in whole blood, while others might contain anywhere from five to ten times the normal amount.

As well as the concentrations of PRP being different, the delivery system is different, the applications are different, the dosage is different, the intervals between treatments are different, and so on.  Other elements can affect the preparation of PRP as well, such as the ratio of white blood cells, certain growth factors and the addition of thrombin or calcium chloride. With so many variations in the methodology, there is little wonder why insurance companies are hesitant to cover the procedure.

The one thing that PRP providers can agree on is that further research is necessary to create a standard model of formulation for PRP, establish its effectiveness and determine the best applications for the treatment. Certain guidelines must be established and observed in order for everyone to use the same procedure to achieve measurable results.

Many doctors agree that PRP may play a vital role in assisting the body in the healing process and can be a valuable option when conservative treatments have failed and surgery is the only alternative. Further testing will eventually show what type of PRP treatment works best for a particular condition.

It’s unlikely that the insurance companies will change their position as long as theeffectiveness of PRP remains in question. It is therefore up to the medical community to create clinical trials to establish PRP as a proven treatment.

If you have a particular PRP success story you would like to share, please feel free to visit our blogs and share it with us.

 

 

 

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