What should you ask about cost and coverage?

What needs to be in writing?

Ask the office for the whole expected charge. It should include the first visit and likely return visits.

Ask whether supplies, a lab, or another office cost more. Several treatments sold together may still leave bills out.

Ask what happens if care stops early. Deposits, missed visits, and refunds belong in writing.

Then call the insurer with the treatment details. Don't rely on the phrase “we take insurance.”

Ask whether the doctor, clinic, or outside lab sends each charge. Coverage may differ for every bill.

If the plan won't pay, request the reason. Compare cash cost with choices needing less money, travel, or clinic time.

Travel belongs in the same total. Add fuel, a ride home, and any return trip.

Evidence sources

1. Medicare's national coverage policy states that CMS covers autologous platelet-rich plasma ONLY for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only within an approved coverage-with-evidence-development clinical study. There is no Medicare national coverage for PRP in knee osteoarthritis, which is why these injections are billed to the patient as cash-pay.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS.gov, 2024.

2. A cross-sectional study contacted 273 of 317 US centres offering direct-to-consumer stem-cell therapy, posing as a 57-year-old man with knee OA. The mean advertised price of a unilateral same-day stem-cell knee injection was $5,156 (SD $2,446), and centres claimed a mean clinical efficacy of 82% (SD 9.6%) — a figure with no support in the published evidence.

   Piuzzi NS, Ng M, Chughtai M, et al. — The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective.. Journal of Knee Surgery, 2018.

3. A BMJ network meta-analysis of 10 large trials in 3,803 patients found glucosamine, chondroitin and their combination all failed to reach the prespecified minimal clinically important difference versus placebo for OA pain (glucosamine -0.4 cm, chondroitin -0.3 cm, combination -0.5 cm on a 10 cm VAS). Industry-independent trials showed SMALLER effects than commercially funded ones (P=0.02 for interaction).

   Wandel S, Juni P, Tendal B, et al. — Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis.. BMJ, 2010.

4. OARSI 2019 designates arthritis education plus structured land-based exercise (with or without dietary weight management) as CORE treatments for knee OA; topical NSAIDs are strongly recommended (Level 1A); oral and transdermal opioids are strongly NOT recommended (Level 5).

   Bannuru RR, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis and Cartilage, 2019.