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How To Maximize Use Of A Fee-For-Service (Indemnity) Health Insurance Policy

If You Need An Unusual Off Label Or An Experimental Treatment

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Insurance companies do not generally pay for experimental treatments. 

They may also balk at paying for off label treatments - use of a drug or treatment other than for the FDA approved use. Some off label treatments are so standard that they are not questioned. At the other extreme, the treatment may be so novel that it would be considered to be experimental. There is the whole gray area in between.

If a treatment you desire could be considered "experimental," work with your doctor to create the strongest argument as to why it's in the insurance provider's interest to pay for it. Get agreement form the insurance company before you take the treatment, or be prepared to pay the entire bill yourself.

Consider reviewing Arguments To Use Against An Insurer’s Denial Of A Health Claim.

We also supply a Sample Letter: Experimental Treatment to help provide some guidance.

NOTE: If the insurer will not pay for If money is part of the equation for you, perhaps you can find a treatment for free through a clinical trial or from a pharmaceutical company that manufactures the drug.


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