Clinical Trial and Grandfathered Insurance Plan

SpooMom

my company’s plan does not cover clinical trials. Does that mean ALL treatment will be denied? I want to do a trial that puts radiation before lumpectomy but don’t want a long delay in treatment if insurance will deny the entire claim.

Standard care is lumpectomy then 5 weeks of radiation. The trial is 5 total radiation treatments then lumpectomy.

Help! Time matters to me and I should drop the trial and have the surgery now if there is no coverage

pajim

That's odd. Why not? You're having the usual treatment, but in a different order.

Usually the trial covers trial drugs, etc., but insurance pays for what they usually pay. If the radiation is experimental, does the trial pay for the radiation treatments? Ask them.

You need to have a long talk with your insurance company rep. Get it in writing what they will and will not pay for. [They should pay for the surgery no matter what]