Convince Private Insurer to cover HA + PRP for Knee Osteoarthritis, HA+PRP
Knee osteoarthritis is a very common problem. My private Health Insurer denied coverage. I found their reasoning to be unconvincing.
Yes, you are able to challenge any decision made by your private health insurer, just like you're able to challenge a decision by a public health payor. For example: often Private Insurers will saw "we don't cover chronic diseases" But what does that mean?
According to a certain logic every single disease is chronic in that it takes time to develop. Even cancer is a chronic disease as the pathogenesis requires time which in some cases may stretch decades.
I protested and asked for the email address to which i could send a document highlighting why my treatment should be approved.
I work for IQVIA and they didn't care to see my LinkedIn profile before denying coverage. They soon found out.
The treatment i wanted to attempt was HA + PRP. A relatively new treatment, common use has only occurred in the past 5 years.
So i did the research and wrote a 10-page document in which outline the clinical evidence and request for approval.
My treatment was approved. I wanted to try HA+PRP and BUPA, my insurer, denied coverage. I successfully challenged them and did my treatment. While it's too early to provide an overall judgement on the outcome i can say that for now the treatment is working well.
The Document is anonymised and can be reused as is. I am pleased to offer help to anyone in need.