Health Insurance

Health Insurance and Clinical Studies

Many cancer patients decide not to participate in clinical studies because they are afraid that their health insurance will not cover their treatment. Before you reject a clinical trial for that reason, ask Seattle Cancer Care Alliance staff for help in determining what coverage you have.

It is unfortunately true that some health plans consider treatment received in a clinical study to be "experimental" or "investigational," and they will deny payment. Sometimes a health insurance plan's decision depends on how the information is presented. If you are considering a clinical trial, you may want to ask your doctor to initiate a discussion of coverage with your health plan.

Health insurance coverage for clinical studies is broader than in the past. About 80 percent of patients who participate in cancer clinical trials have health insurance that pays for at least part of their care. A number of states have passed legislation requiring health plans to pay the cost of routine medical care for patients in clinical trials, although Washington state is not among them. Both Medicare and the Veterans Administration will pay for treatment received in clinical trials, with some restrictions.

Once you and your doctor have decided that a clinical study is right for you, talk to SCCA Patient Financial Services about health insurance coverage. The Patient Financial Services staff will give you detailed information about the costs involved with a clinical trial and help you with insurance paperwork. Call (206) 288-SCCA (7222) to talk to a Patient Financial Services representative.