How Orthobilogic Research is Influencing Insurance Coverage

Orthobiologic treatments, including the platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) treatments Dr. Bodor uses to treat problems of the spine, joints, tendons, nerves, and ligaments, are relatively new and have only become widely utilized in the last five to ten years. Historically, insurance providers have not covered these treatments. However, experts like Dr. Andre Terzic of the Mayo Clinic, agree that new discoveries in regenerative medicine are influencing change: “The Mayo Clinic has embraced regenerative medicine as a strategic investment into the future of health care. In essence, regenerative medicine allows us to increasingly understand the causes of disease and increasingly offer cures for otherwise untreatable conditions.”

Legitimizing Regenerative Orthopedics One Research Study at a Time

Since its founding, Dr. Bodor and the Napa Medical Research Foundation (NMRF) have been contributing to the research advances that are convincing insurance providers like the Veteran’s Administration, Tricare, and workmen’s compensation to cover orthobiologic treatments.

For example, Tricare, the insurance provider for military soldiers and officers, covers PRP procedures for the knee and elbow, areas which have received the most attention from research.

Dr. Bodor is a prodigious contributor to this effort and even during a difficult 2020, he has published two articles, three book chapters, and started a ten-year study comparing biologic repair of ACL injuries with the current standard surgical treatment.
Dr. Bodor and his team’s most recent publication “Human Mesenchymal Stem Cells Respond Differentially to Platelet Preparations and Synthesize Hyaluronic Acid in Nucleus Pulposus Extracellular Matrix” in The Spine Journal is an important advancement in understanding how leukocyte poor (low white blood cells) PRP is more likely to improve medical outcomes for patients with chronic pain originating from a damaged vertebral disc.

Looking forward to 2021 and beyond, Dr. Bodor and his research staff at NMRF expect to add to the knowledge base with randomized controlled trials for pain in the neck stemming from whiplash and from the very common osteoarthritis of the base of the thumb, which affects 50% of women above the age of 50.

Changing Perspective Amongst Insurance Companies

Joy Ortstadt, office manager at the Bodor Clinic, has seen a steady increase in the number of procedures covered by insurance in the past few years. “Worker’s compensation is the main one that is covering our procedures because it ends up saving them money in the long run by avoiding costly surgeries.” Ortstadt also explains that other insurance companies will sometimes cover PRP for certain issues, such as lateral epicondylitis (tennis elbow) when traditional therapies such as physical therapy and pain medications are unsuccessful.

Continued double blind research studies are necessary to drive increased insurance coverage for regenerative procedures because they legitimize what patients and doctors in the field already know – that these treatments work very well for certain conditions. The NMRF will continue to do its part.