Frequently Asked Questions

Deciding whether or not to participate in a clinical trial/study is a difficult decision to make. To assist you, we have compiled a list of frequently asked questions and answers that may provide you with the information you need to make this important decision. The information below has been borrowed from the National Institutes of Health's cancer.gov website.

What factors affect whether your health insurance plan will pay for a clinical trial?

Health insurance companies and managed care companies decide which health care services they will pay for by developing a coverage policy regarding the specific services. In general, the most important factor determining whether something is covered is a health plan's judgment as to whether the service is established or investigational. Health plans usually designate a service as established if there is a certain amount of scientific data to show that it is safe and effective. If the health plan does not think that such data exist in sufficient quantity, the plan may label the service as investigational.

Health care services delivered within the setting of a clinical trial are very often categorized as investigational and not covered. This is because the health plan thinks that the major reason to perform the clinical trial is that there is not enough data to establish the safety and effectiveness of the service being studied. Thus, for some health plans, any mention of the fact that the patient is involved in a clinical trial results in a denial of payment.

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