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Glossary of Health Insurance Terms To Know

Experimental Treatment

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The definition of "experimental treatment" varies from policy to policy.

In general, an experimental treatment is one which is not generally accepted in the medical community. For instance, the following tend to be considered experimental:

  • Treatments which are undergoing clinical trials.
  • Treaments for which there are no relevant articles in peer reviewed medical journals (journals in which articles are reviewed by other experts in the relevant field).
  • A treatment which does not have the support of the majority of medical practitioners in the relevant field.
  • A treatment which is being used in another way than has been approved by the FDA or is in general use for the particular medical situaiton.
  • A treatment which is being used in a different body area than the use generally accepted in peer reviewed medical journals.
  • A drug which is used "off label" - the intended use differs from the FDA approved use. 

If the wording of "experimental treatment" is not clear, courts tend to interpret the definition in favor of the insured.

NOTE: If you want to appeal an insurance company decision to deny coverage on the basis that what you want to do is "experimental", click here for a sample letter.

For information about clinical trials, click here.

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