I was astonished when I saw a press release from a new medical provider in California that trumpeted their orthopedic stem cell and platelet procedures were covered by Medicare and most PPO insurance companies. To the best of my knowledge, all platelet and stem cell procedures done on an outpatient basis are not covered by any health insurance company, and especially not by Medicare. So I went back to my billing folks and asked them if anything had changed regarding coverage for the procedures. When they said no, I then researched it myself to be certain that my people were giving me accurate information, which re-affirmed that my assumptions were true.
So, being the curious guy I am, I called the operation who was advertising on the web and in the press release and was told that the procedure was in fact covered by many insurance companies, however they could only confirm coverage after reviewing the benefits of my plan. I explained that I had Medicare with a supplemental and was told that they would have to look into the coverage details of my secondary supplemental benefits. In any case, I would have to pay out of pocket for the “kit” that would be used for the marrow draw to obtain my stem cells, but the actual injection may be covered. The young lady suggested that I make an appointment for a consultation with the doctor and they would then advise me what was covered and what was not.
It is apparent to me that either this operation is billing fraudulently or is running a “bait and switch” with patients. The old used car sales philosophy of get them in the door and we will get as much as we can from the client seems to be their method of operation. This is very upsetting to me as we have had several candidates wanting to undergo our procedures insist that it was covered by their insurance.
I want to assure our patients that we will accurately and ethically bill Medicare and other insurance carriers for all procedures that are covered by their policies. We also continuously monitor all changes, especially of procedures that are currently considered “experimental or investigational” and are not covered. It is unfortunate that some physicians participate in insurance fraud as it reflects poorly on the entire medical profession. Health Link Medical Center and Regenexx maintains the highest standard of patient care and integrity. We are here to serve our patients with the world’s most advanced biological cellular therapies for orthopedic conditions.