Insurance-Provider Reference for Qualified Clinical Studies

Below are some resources from common insurance providers that may provide information to ensure that aspects of medical billing and collections are handled in accordance with the applicable policies and legislation.

All insurance providers’ policies differ, check with your insurer for complete information about your individual plan.

Affordable Care Act Implementations - Coverage for Individuals Participating in Approved Clinical Trials

Medicare Coverage

For more information on Medicare coverage and the Clinical Trials Final National Coverage Decision NCD, please visit the U.S. Department of Health & Human Services CMS Medicare Coverage Database. The current policy, National Coverage Determination (NCD) for Routine Costs in Clinical Trials (310.1), effective July 9, 2007 is available here.

Virginia Legislation

The Virginia Legislation provides information in Title 38.2-3418.8: Coverage for clinical trials for treatment studies on cancer and Title 38.2-3453: Clinical trials. The Commonwealth of Virginia Mandated Benefits and Mandated Offers are available here.

Aetna

Clinical Policy Bulletin: Clinical Trials, Coverage of Routine Patient Care Costs is available here. Updated May 2, 2014. FAQs about members participating in clinical trials is available here.

Anthem

Coverage for individuals participating in clinical trials is available here. Coverage for Members in Clinical Trials is available here. Effective January 1, 2014.

Cigna

Clinical Trials Fact Sheet is available here. Updated May, 2014.

Policies for members participating in clinical trials is available here.

United Healthcare

Question and Answers about member participation in Clinical Trials is available here. Updated 2014.