Trials involving human patients are crucial to the advancement of clinical science. But they’re not without risk. Fortunately, insurers are willing to cover them.

Westhill Insurance Consulting, one of the most trusted on-line insurance consultant that offer consumer information on reasonably priced health and medical coverage has these following things to review if you are planning to take part in a clinical test.

Here are the conditions the federal law requires for a health insurance to cover:

• You must be eligible for the trial
• The trial must be an approved clinical trial
• The trial does not involve out-of-network doctors or hospitals, if out-of-network care is not part of your plan
• Also, if you do join an approved clinical trial, most health plans cannot refuse to let you take part or limit your benefits.

Approved clinical trials are research studies that:

• Test ways to prevent, detect, or treat cancer or other life-threatening diseases.
• Are funded or approved by the federal government, have submitted an IND application to the FDA , or are exempt from the IND requirements. IND stands for Investigational New Drug. In most cases, a new drug must have an IND application submitted to the FDA in order to be given to people in a clinical trial.

Health plans are not required to cover the research costs of a clinical trial. Examples of these costs include extra blood tests or scans that are done purely for the sake of the clinical trial. Often, the research sponsor will cover such costs. Warnings must be posted days before the outcome to prevent further complaints from both the sponsor and the insurance company.

Plans are also not required to cover the costs of out-of-network doctors or hospitals, if the plan does not usually do so. But if your plan does cover out-of-network doctors or hospitals, they are required to cover these costs if you take part in a clinical trial.

Clinical tests which are made in a different city such as those in Tokyo, Japan, Jakarta, Indonesia and Kuala Lumpur, Malaysia may not be included in the coverage as well.

Challenging trials

One challenge for underwriters is the relatively small premium base measured against a trend for higher [insured] limits to be requested.

Clinical trials policies normally have “claims made” wordings which means that insurance coverage does not automatically extend beyond the trial dates. The potential gap is where you arrange insurance, let the policy end and have no insurance for an event which may occur sometime in the future that can be attached to the clinical trial.

Serious problems in clinical trials are rare, as Rossano points out. “But what I would say is that clinical trials are not without risk. The risk of a clinical trial is that the human body is very complex and in rare cases there can be unforeseen outcomes, as happened in cases like TeGenaro.”

World Health Organization (WHO) has stated that universal health coverage – ensuring that all people obtain health services they need without suffering financial hardships when paying for them – is a global priority for this year. They also declared that universal health coverage as “the single most powerful concept that public health has to offer”.

Several developing countries such as Indonesia, the Philippines, Rwanda, Vietnam, Kenya and Nigeria among others have demonstrated a strong commitment to universal health coverage, with many others slated to follow suit. Jakarta, the capital of Indonesia is already paving its way to offering a more extensive health insurance coverage that can cater different places in the inter-island archipelago.

Westhill Insurance Consulting Company, your guide to health insurance concerns located in Australia has been in partnership with varied insurance companies which has the goal of expanding the reach of health insurance. 

Given this momentum, it is time to think critically about how the goals of universal health coverage can be advanced through health insurance to ensure that women worldwide are empowered to choose the size, timing, and spacing of their families.

Health insurance pays for all or part of medical or surgical expenses for the insured, mitigating out- of-pocket payments as a barrier to health care and providing financial risk protection against catastrophic health expenditures. Different types of insurance models have varying funding sources and provider payment. Many countries have some form of insurance program in place and coverage has increased considerably.

Many reviews say that it would be better for insurance companies to include family planning in their policies and terms especially in over-populated countries like Indonesia which remains the 4th most populous in the world and China which tops the chart. It is well established that family planning results in benefits beyond reducing unmet need and lowering fertility—benefits such as fewer maternal and child deaths and complications from abortions; and improved nutrition outcomes among women, infants, and children. Given the high cost of addressing maternal and child health, these benefits can lead to considerable savings for health systems and insurance providers. Critics have complaints though that if this be passed, couples can make this reason for pre-marital sex which continues to be a moral issue in countries centered by this insurance idea.               

When developing insurance programs, governments and health insurance providers must carefully decide on a benefits package that clearly describes the types of services covered, along with levels of coverage and any applicable exclusions and/or limits on services. Since lack of access and inability to pay are important reasons women do not use family planning, inclusion of family planning services in health insurance programs could increase uptake. The Commission on Macroeconomics and Health has suggested criteria for choosing essential health interventions. Family planning is a strong match to the key criteria because it is a technically effective intervention, can be delivered successfully, addresses health issues that impose a heavy burden on society, and has benefits beyond the intervention itself.

Most of us who are employed know that we have corresponding health insurance. For others who choose their own insurance, agents might have explained what should be provided and covered for our policies. One of the things that we should be aware of is the type of a managed care plan we need: either an HMO or PPO to avoid complaints, frustrations and disappointments added to our consultation to the doctor. If this is the first time you are hearing this, then, you are not alone. Some insurance are already fixed that agents do not care to mention it anymore.

Westhill Insurance Consulting took the liberty to differentiate each one from the other.

HMO actually stands for Health Maintenance Organization while PPO is an abbreviation of Preferred Provider Organization. Less common are point-of-service (POS) plans that combine the features of an HMO and a PPO. In developing cities like Singapore, Kuala Lumpur, Malaysia, Jakarta, Indonesia and Beijing China, HMO is mostly used by employers for their health care insurance.

To put into an outline, here are the facts that are needed to be reviewed and considered between the two:

Do I need to choose doctors, hospitals and other providers?

•              HMO: you must choose doctors, hospitals and other providers

•              PPO: you can choose doctors, hospitals and other providers.

Do I need to have a Primary Care Physician (PCP)?

•              HMO: Yes, your HMO will not provide coverage if you do not have a PCP.

•              PPO: No, you can receive care from any doctor you choose. But remember, you will pay more if the doctors you choose are not "preferred" providers.

How do I see a specialist?

•              HMO: Referral is needed from your PCP to see a specialist or if you have to undergo other special test exams such as x-rays, except in emergency situations. Your PCP also must refer you to a specialist who is in the HMO network.

•              PPO: You do not need a referral to see a specialist. However, some specialists will only see patients who are referred to them by a primary care doctor. And, some PPOs require that you get a prior approval for certain expensive services, such as MRIs.

Do I have to file any insurance claims?

•              HMO: All of the providers in the HMO network are required to file a claim to get paid. You do not have to file a claim, and your provider may not charge you directly or send you a bill.

•              PPO: If you get your healthcare from a network provider you usually do not need to file a claim. However, if you go out of network for services you may have to pay the provider in full and then file a claim with the PPO to get reimbursed. The money you receive from the PPO will most likely be only part of the bill. You are responsible for any part of the doctor's fee that the PPO does not pay.