My current in network provider does not have access to a clinical device trial I'd like to join and an out of network provider does. Can I join the trial and follow up with the out of network provider for standard of care follow up and have my insurance cover it?
I would ask Medicare directly, but I found the following information:
Clinical research studies
How often is it covered?
Medicare covers clinical research studies, which test different types of medical care, like how well a cancer drug works. These studies help doctors and researchers see if a new treatment works and it's safe. Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover some costs, like office visits and tests, and in certain qualifying clinical research studies.
Who's eligible?
All people with Part A and/or Part B are covered, in qualifying studies.
Your costs in Original Medicare
You may have to pay 20% of the Medicare-approved amount, depending on the treatment you get. The Part B deductible may apply.
Medicare will help pay for some of your costs if you join a covered clinical research study.
Medicare pays routine costs for items and services, including:
Room and board for a hospital stay that Medicare would pay for even if you weren't in a covered research study.
An operation to implant an item that’s being tested.
Treatment of side effects and complications that may result from the study.
Medicare won't pay for:
The new item or service the study is testing (except for certain medical devices) unless Medicare would cover the item or service even if you weren't in a study.
Items and services the study gives for free. Many times the study sponsor will give the treatment for free.
Items or services given only to collect data and not used in your direct health care, like monthly CT scans for a condition that usually requires only a yearly scan.
Coinsurance and deductibles.