Stem Cell Transplant (SCT) a BCBS Policy

This article, although a Policy written by Blue Cross Blue Shield of Alabama, does a good job spelling out this Insurer’s reasoning regarding auto-immune disease treatment options and justification for the policy.

Medical Policy #485 Name of Policy: Hematopoietic Stem-Cell Transplantation for Autoimmune Diseases
Policy #: 485 Latest Review Date: February 2016

https://www.bcbsal.org/providers/policies/final/485.pdf This is a 16 page .pdf document.

Summary: “Policy: Autologous or allogeneic hematopoietic stem-cell transplantation does not meet Blue Cross and Blue Shield of Alabama’s medical criteria for coverage and is considered investigational as a treatment of autoimmune diseases, including, but not limited to multiple sclerosis, juvenile idiopathic and rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis/scleroderma, Type I diabetes mellitus, and chronic inflammatory demyelinating polyneuropathy.”

Not covered…..Something you’ve read about from Jim-LA.

Note that they don’t say don’t do it. They don’t even say it doesn’t work. They only say let your doctor choose the best medical treatment for you and that it is considered Investigational and they won’t pay for it.

An excerpt: “Physicians should always exercise their best medical judgment in providing the care they feel is most appropriate for their patients. Needed care should not be delayed or refused because of a coverage determination.”