Getting Insurance for Clinical Trials

You might decide that a clinical trial, offering a new treatment or drug, is the best approach for you. But your insurance plan might differ, at least when it comes to your coverage. Currently, some insurance plans won't pay for your radiation or chemotherapy if you are also in a clinical trial., says Rachel Tyree, a spokeswoman for the American Cancer Society's government relations office. Some will pay for one phase of a trial but not the next. (Listings of clinical trials by specific cancer and geographic location are posted at, a site developed by the National Institutes of Health.)

If your insurance company isn't doing all you think it should for you when you want to participate in a clinical trial, you can follow the same avenues of appeal as you do when other requests for care are declined. (See "When Your Insurer Says No, Take Action," above.) In addition, you should know about the following developments:

  • In 2000, President Clinton signed an executive order requiring Medicare to cover the routine health care costs of patients eligible for clinical trials.
  • Soon, access may be easier for others as well. In March, 2001, four U.S. representatives introduced the Access to Cancer Clinical Trials Act, which requires all private health insurance plans to provide coverage for the routine costs of cancer patients who qualify to participate in a clinical trial. The proposed act, H.R. 967, has been referred to the House Ways and Means Subcommittee on Health. Several other proposals include similar provisions for coverage of clinical trials, and advocates hope one of these bills will eventually become law.

Protecting Your Coverage

Once treatment is complete and you're on the road to recovery, you might start to worry about the effect a cancer diagnosis will have on your health coverage in the future.

In recent years, access to health insurance for people who have been treated for cancer and other serious conditions has improved, thanks to the Kassebaum-Kennedy Act, also known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

What does HIPAA do?

  • It was created to make it easier to move from one job to another without losing group health coverage. Under HIPAA, for instance, group health plans can't deny an application for coverage solely due to health status.
  • HIPAA also limits the exclusions for pre-existing conditions such as cancer. In general, it provides more protection for those in group health plans, but it does provide some protection for those in individual plans.

    To get answers to specific questions about pre-existing conditions and other coverage concerns, go to the Centers for Medicare and Medicaid Services website.

    Because state laws governing insurance differ greatly, check in with your state department of insurance or other departments that regulate managed care or insurance. You can link to your state site via the National Association of Insurance Commissioners site at.

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