Insurance Factors to Consider with Clinical Trials

Although it is vital you understand your insurance plan regardless, it is important to really read and understand what may or may not be covered under your plan as it relates to clinical trials if you think you might be interested in participating.

Some specific areas to keep an eye out for include:

  • Reading your Covered Benefits
  • Reading your Non-Covered Benefits
  • reading your Exclusions of plan language

After reading your plan language you should be more aware of what is and what is not covered. Many states have passed laws or developed policies requiring health plans to cover the costs of certain clinical trials. If your insurance company denies coverage, file an appeal to your provider and request they reconsider and provide coverage for the requested treatment. Include important details like why the treatment is a medical necessity for you. Additionally, there may be some funds available through the trial sponsor to assist you and fundraising organizations that might be able to offset the costs and provide additional clinical trial information.

There are many great benefits to participating in a clinical trial. Occasionally patients will run into obstacles but many of these can be overcome with education regarding your options and availability of resources.

Things you can do to minimize obstacles include:

  • Maintaining an open line of communication with your doctor. A doctor may perceive lack of interest, so be sure to let him know you are interested and are open to clinical trials.
  • A clinical trial may not be available locally. If this is the case, know that there are many transportation resources available. Many hospitals and treatment facilities also offer assistance to help offset these costs. Some programs offer assistance to help offset transportation costs. Additionally, some programs offer assistance with lodging and meals free of charge to help with the costs. If you’re staying in a hotel, inquire whether they have a medical rate that is more affordable than the standard care of lodging.
  • Loss of income not only for the patient but also for the caregiver. There are programs available to you through your employer, including Short Term Disability, Long Term Disability and Family Medical Leave Act. You can also access your sick pool donations and altered work schedule. If treatment lasts longer than a year, apply for Social Security Disability Income or Social Security Income.

Although there may be challenges associated with clinical trials, don’t let them dissuade you from exploring all your treatment options. Clinical trials can offer life-saving treatment and allow you to experience break-through technology, treatments, and cures for your disease.

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