While Ebola is in the headlines, and the treatment of the aid workers with the "experimental drug, known as ZMapp," is being extensively discussed, eg by CNN in "Experimental Drug likely saved Ebola patients," by Dr. Sanjay Gupta and Danielle Dellorto, 8/5/2014, CNN.com, there are many circumstances where you might be willing and even eager to try an experimental drug, such as a new cancer drug or treatment.
Unfortunately, in many instances you’ll be paying out of pocket for the same or at the very least find yourself involved in an appeal process with your insurance company after an initial denial for coverage of the expense of the drug.
Having already addressed the Ebola situation as an opportunity to discuss TRAVEL MEDICAL INSURANCE, “Travel MEDICAL Insurance: Abroad, Ebola to Flu,” http://conoutofconsumer.blogspot.com/2014/08/travel-medical-insurance-abroad-ebola.html, here we discuss EXPERIMENTAL DRUGS like ZMapp being used on the two aid workers infected with Ebola who have made the news recently.
If you’re curious about your own health insurance policy’s provisions regarding experimental drugs or emerging treatments, you can inquire their policies by calling them or by asking where to look in your policy document. As always be careful of what is NOT promised by insurance companies.
For instance, in an August 7, 2014 article entitled, “Ebola: Health insurance companies stay calm but alert,” Beth Orenstein provides some insight into the roles health insurance companies prefer…AND THEY’RE NOT ROLES THAT COST MONEY, eg covering costs, http://www.insure.com/articles/healthinsurance/ebola-health-insurance-companies.html.
The article includes quotes from Dr. Ajani P. Nimmagadda, described as “Senior Medical Director for CIGNA,” http://www.insure.com/articles/healthinsurance/ebola-health-insurance-companies.html.
First, Dr. Nimmagadda states that Cigna keeps patients “INFORMED.”
Second Dr. Nimmagadda states that Cigna “EDUCATES its health care providers and members about…[prevention], bragging, “WE REMIND THEM OF THE NEED TO WASH THEIR HANDS.”
Third, Dr. Nimmagadda states, “Should an outbreak of infectious disease occur, Cigna would follow the guidance of the CDC and local health authorities,” INFORMING providers and members of steps to take, http://www.insure.com/articles/healthinsurance/ebola-health-insurance-companies.html ( the link is hinky, search by article title, “Ebola: Health Insurance companies stay calm but alert.”
The article continues with Cynthia Michener, “spokesperson for Aetna,” who also promises that Aetna, “does what it can to ensure its members are able to access necessary care,” 8/17/14, “Ebola: Health insurance companies stay calm but alert,” Beth Orenstein, http://www.insure.com/articles/healthinsurance/ebola-health-insurance-companies.html.
Inform, educate, monitor, providing access to necessary care. The basic interest we have in an insurance product is omitted, that it helps pay for the medical care and services we need in the event we become ill.
The two aid workers were treated with an experimental drug, ZMapp. For our purposes it could be an experimental cancer drug or some other drug or treatment you are interested in. How would your insurance cover it? Let’s see what Aetna spokesperson and Cigna physician did not mention.
For Cigna, on the page, “Emerging Treatment (Experimental),” http://www.cigna.com/cigna-healthcare-policies#Emerging%20Treatment%20%28Experimental%29, you’ll find that Cigna “evaluate[s] requests for coverage for new treatments on a case-by-case basis.” It’s important that you understand the Appeal process if you have Cigna.
Aetna’s coverage of “experimental or investigational technologies” requires “All of the following criteria are met,” http://marketing-healthinsurance.aetna.com/media/pdf_plans/NY_Experimental.pdf, including the requirement that the “member is part of a clinical trial satisfying ALL of the following criteria,” followed by a list. It’s important you understand your appeal process if you have Aetna.
