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Will insurance pay for clinical trial costs - blood work, scans every 6 weeks, etc.?

califsue
Posts: 80
Joined: Oct 2007

Does anyone have experience with insurance coverage for clinical trials. The ones that I am looking into, the drug companies will foot the bill for the drugs and that's it.

Would it be better to have a PPO plan rather than an HMO plan? I have an opportunity to switch, but the window closes today of course.

I was thinking that now, since my situation has changed, the HMO insurance that had been working for me, may not be a good plan now that I am out there having to look for clinical trials.

(Yes, I am grateful that I am one of those Americans that even has insurance.)

Thank you in advance for your knowledge.
Susan

pf78248's picture
pf78248
Posts: 209
Joined: Jul 2008

Susan,

My husband David was in a clinical trial when he was stage 3, now stage 4, and our insurance paid for everything except the trial drug, which was paid for by the drug company. I think that's pretty standard.

I can't really advise about an HMO versus a PPO. We've never been in an HMO. Insurance coverage varies so much. And I, like you, am very grateful to have coverage for myself and my husband.

In our PPO, we pay a monthly premium, a $2400 a year deductible, then pay 10 percent of the bills up to a maximum out of pocket. Once we reach that, insurance pays 100 per cent. With cancer, it doesn't take too long each year to reach that maximum. We still have to go to network doctors, unless we want to pay a lot more. The good news is that all the major cancer centers are considered network, so now David is receiving treatment at M D Anderson in Houston.

Good luck with your decision. If you have friends, coworkers, or acquaintances in your same plan, they can probably give you better advice. Thanks for letting me add my two cents worth!

Priscilla

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