What Insurance Companies Cover PRP Injections?

what insurance companies cover prp injections
what insurance companies cover prp injections

Platelet-rich plasma (PRP) injections have recently become an increasingly popular treatment option for various medical conditions. PRP therapy involves taking a sample of the patient’s blood, processing it to concentrate the platelet levels, and then injecting this concentrated plasma back into the injured or affected area to stimulate healing.

While PRP injections have shown promising results for conditions like chronic tendon injuries, osteoarthritis pain, and even hair loss, many patients find themselves wondering – what insurance companies actually cover these treatments?

Let’s take a closer look at PRP therapy, its applications, effectiveness, controversies, and how to find out if your health insurance will cover PRP injections.

What Insurance Companies Cover PRP Injections

What Insurance Companies Cover PRP Injections?

For example, TRICARE covers PRP injections for mild-to-moderate knee osteoarthritis and chronic tennis elbow cases unresponsive to other conservative therapies.

Here are some of the major US health insurance providers and their PRP coverage policies

Aetna

Aetna covers PRP injections as part of revision surgery for failed rotator cuff repairs. Other applications may be covered if deemed medically necessary on a case-by-case basis.

Anthem Blue Cross Blue Shield

Anthem BCBS provides coverage for PRP injections to treat chronic tendon injuries, plantar fasciitis, tennis elbow, and other orthopedic conditions unresponsive to other therapies.

Cigna

Cigna offers coverage for PRP therapy for elbow, shoulder, hip, knee, and ankle conditions in certain plans. Pre-approval and other requirements may apply.

Humana

Humana considers PRP experimental and investigational for most conditions and does not routinely cover it except when participating in an approved clinical trial.

UnitedHealthcare

UnitedHealthcare provides limited coverage for PRP injections, requiring pre-approval and proof of medical necessity like failed, more conservative treatments.

Can I Get PRP Covered By Insurance?

The question of what insurance companies cover PRP injections does not have a straightforward yes or no answer. Coverage can vary significantly depending on your specific health insurance plan, the medical rationale behind getting the injections, and in some cases, the provider you go to.

Here are some key factors that determine whether PRP therapy will be covered by health insurance:

  • Type of health insurance plan – More comprehensive plans may offer PRP coverage, while basic or catastrophic plans likely won’t.
  • Medical necessity – Insurers are more likely to cover PRP if it is deemed medically necessary and not just cosmetic. For injuries, it helps to try conventional treatments first before PRP.
  • In-network providers – Seeing an in-network PRP provider for your insurance increases the chance of coverage.
  • Pre-approval – Getting pre-approval from the insurer before getting injections can help ensure some coverage.
  • Condition treated – PRP for chronic orthopedic conditions may be covered more than aesthetic uses like hair restoration.
  • Number of treatments – Insurance may cap the number of covered PRP sessions, beyond which you pay out-of-pocket.

While coverage is not guaranteed, the above factors improve your chances. Some major health insurance companies like Cigna, Aetna, and Blue Cross Blue Shield cover PRP therapy for certain medical conditions, especially when more conservative treatments have not helped.

Why Isn’t PRP Covered By Insurance?

While some major insurance companies offer limited coverage, there are a few key reasons why PRP injections are still not more universally covered:

Lack of Definitive Clinical Evidence

Much of the current research on PRP therapy is limited to smaller studies. Large-scale randomized control trials showing definitive evidence of PRP’s effectiveness are still lacking for certain conditions. This makes many insurers consider it experimental or investigational.

Not FDA-Approved for All Uses

The FDA has only approved PRP for specific uses like bone grafting. PRP injections for other conditions like tendinopathy, arthritis, and hair loss are currently off-label uses. This also contributes to insurers denying coverage.

High Costs

A single PRP injection can cost over $1,000 in some cases. From the insurer’s perspective, this is significantly more expensive than things like steroid injections covered for similar problems. The high costs and number of repeat injections lead many companies to deny coverage.

Considered Elective

For conditions like osteoarthritis, chronic tendon injuries, and hair loss, PRP injections are still considered elective, non-essential procedures by most insurance companies. They do not see it as medically necessary and therefore do not cover it.

What Is The Success Rate Of PRP Injections?

What Insurance Companies Cover PRP Injections
The effectiveness of PRP injections can vary based on the condition it is used for. Here is a look at PRP’s success rate for some common treatment applications:

  • Tendon injuries – Multiple studies show PRP improves pain and function in chronic tendinopathies like tennis elbow, plantar fasciitis, and patellar tendonitis. Up to 73% of patients see positive results.
  • Osteoarthritis – Arthritis patients treated with PRP injections over 6 to 12 months show improved joint function and reduced pain compared to more conservative treatments.
  • Acute muscle injuries – For acute hamstring strains or calf muscle tears, PRP injections combined with physical therapy can cut healing time in half compared to just physical therapy alone.
  • Hair loss – Around 60 to 70% of patients see some measurable increase in hair density after three PRP treatments. However, results are variable with hair loss.
  • Skin rejuvenation – PRP facials can improve skin texture, wrinkles, pore size and collagen synthesis, but the results are temporary, lasting 6 to 12 months for most patients.

So in conditions like tendon injuries, arthritis and acute muscle tears, PRP appears to have a relatively high success rate. But for uses in dermatology and cosmetics, the results are more modest and temporary.

Why Is PRP Controversial?

The increased use of PRP therapy has also been surrounded by some controversy recently. Here are some of the concerns:

  • Limited evidence of effectiveness – As mentioned earlier, high-quality evidence supporting PRP is still lacking for many conditions beyond a few small studies. This leaves questions about its true usefulness.
  • Unknown long-term effects – The long-term effects and safety of repeated PRP injections are still unknown. There is a concern about ill effects over time.
  • Risk of complications – Potential side effects include injection site pain and local tissue damage. In rare cases, PRP could worsen existing illnesses.
  • High costs – PRP treatments cost thousands of dollars out-of-pocket. Critics argue companies are profiting from an unproven treatment that is not covered by insurance for most people.
  • Unregulated industry – There is little regulation governing PRP preparation methods and injection techniques. Quality control is a concern.

So until larger clinical trials demonstrate PRP’s effectiveness conclusively and standardized regulations are implemented, the skepticism around platelet-rich plasma therapy will likely persist amongst certain medical professionals.

PRP Treatments Covered by Insurance

During PRP treatment, the concentrated platelet level is typically 5 to 10 times higher than normal blood. This provides a concentrated dose of growth factors to stimulate tissue regeneration.

When standard treatments fail, PRP may provide a minimally invasive approach to finding relief from chronic injuries and pain.

However, coverage depends on the insurer, diagnosis, medical evidence of need, and other factors. Consulting your provider is key to learning if PRP therapy can be covered in your specific case.

The Bottom Line

PRP injections offer an appealing treatment option for those suffering from chronic injuries, pain, and other conditions who have not found relief from more conservative therapies.

While health insurance coverage for PRP is limited for now, it is a good idea to check your plan’s policies on this emerging therapy, consult with in-network providers about medical necessity, and seek pre-approval where possible.

For the right patient with the appropriate indications, who is not finding results from other treatments, PRP therapy could provide that long-awaited breakthrough. Working closely with your health insurer and doctors, you may just be able to get those potentially life-changing PRP injections covered after all.

Be the first to comment

Leave a Reply

Your email address will not be published.


*