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Why don’t insurers cover experimental treatments?

On Behalf of | Nov 8, 2021 | Firm News

A lot of people take comfort knowing that they have health insurance. But when a medical emergency strikes and these individuals turn to their insurance on their reliance on help paying medical expenses, these individuals are oftentimes quickly disappointed.

Given that insurance companies are in the business of making money, they find a number of ways that they can deny your insurance claim, depending on the circumstances. In some instances, these insurers argue that the treatment that was provided or is sought is too experimental to qualify for coverage.

Addressing experimental treatments

When an individual faces a serious medical condition that has failed to respond to traditional forms of treatment, medical professionals may get creative and offer new treatments or new methods of utilizing existing treatments. Yet, insurance companies tend to deny covering these treatments, arguing that they lack a track record of effectiveness, are costly, and are less likely to lead to positive outcomes for the patient. Insurers even argue that these treatments are sometimes harmful to patients. This, of course, leaves many patients frustrated, angry, and scared.

The problem is that most insurance policies don’t clearly define what constitutes an “experimental treatment.” While the thought is that insurance coverage would promote testing of new treatments to ensure their efficacy and therefore lead to better outcomes for patients, the fact of the matter is that the power of insurance companies has left many effective but unprofitable treatments in the dark and rendered them extremely expensive for those patients who seek them.

Don’t lose hope

Although your insurance company may initially deny a treatment sought by you or a loved one, you shouldn’t despair. After all, you can gather medical evidence and statements from medical providers that indicate that the treatment is less “experimental” than claimed by the insurance company. We realize that challenging a denied insurance claim can be a daunting task, which is why it may be wise to approach these matters with the assistance of an attorney who is well-versed in this area of the law.