Insurance coverage questions often arise when someone considers taking part in a research study. They wonder what the costs will be and whether their insurance will cover it.
Study consent forms can provide potential participants with valuable information, including the costs to the patient and/or the patient’s insurance company. Normally, there is a section in consent forms called “What are the Costs? that serves as a first step in identifying and learning what procedures or visits may or may not be billed to your insurance.
It’s important to note that typically, these are routine care procedures and visits for the diagnosis, which would occur even if the patient did not take part in the study.
Additionally, some research studies may compensate the patient for their travel expenses or time. This information can be found under the consent form’s “Will I Be Paid for Taking part in This Study?” section.
Texas requires most health plans to pay the cost of routine, necessary medical care received while serving as a participant in a clinical trial. However, every insurance company has its own set of rules concerning qualifications for coverage. Some may require pre-approval, additional documentation, etc. Additional information can be obtained by asking the study’s research coordinator or billing specialist for assistance.
General guidance to help patients determine if their insurance company will cover procedures/visits for a research study also can be found on the National Cancer Institute website. Although this is a cancer-related website, the guidance is also appropriate for non-cancer-related studies.