Patients with chronic wounds that we treat sometimes have private health insurance, which means one of the first questions we hear is: Will my insurance cover this?
The honest answer? We’ll always run your private insurance, but in our experience, it’s very rare (as of September 2025) for commercial plans to cover advanced wound care treatments, like the use of skin substitute grafts.
Related: Does Medicare Cover 100% of Advanced Wound Care Treatments?
Even when coverage look-up tools or prior authorization portals say a treatment is approved, many insurers still deny payment once the claim is submitted. This is frustrating for patients and providers alike, which is why we believe in setting clear expectations from the start.
In this article, we explain what we see across major private carriers, why denials are common, and what options exist if coverage is denied.
Why Private Insurance Rarely Covers Skin Substitutes
Many commercial carriers still classify skin substitutes as “unproven” or “not medically necessary,” arguing there isn’t enough long-term data to justify widespread coverage outside of very specific cases, like diabetic foot ulcers.
While true that studies are limited, our internal data tells a different story.
We reported a 98.6% wound improvement rate among patients we treated in the second quarter of 2025. That data was representative of 143 patients across Virginia, South Carolina and New York. Of those patients, 140 experienced measurable improvement in their wounds, meaning the size of their wound decreased during our treatment window.
Additionally, of those patients treated, only 1.6% experienced a hospital readmission due to a wound-related complication.
Unfortunately, those strong clinical outcomes aren’t being taken into consideration by commercial carriers.
Here is what we see across some of the major insurers:
Note: No matter the insurer, coverage almost always hinges on at least 28 days of documented conservative care. If that documentation is incomplete or missing, claims are routinely denied, even if the patient would clearly benefit from advanced treatment. Learn more about when a skin substitute graft is used for a chronic wound.
Does UnitedHealthcare Cover Skin Substitute Grafts?
UnitedHealthcare (UHC) covers EpiFix® and Grafix® for diabetic foot ulcers only, under the general criteria of 4+ weeks of conservative care, adequate circulation, and a clean wound bed. Additionally, it follows the rule of one application per week for a max of 10 treatments over 12 weeks.
Outside of those specific products and wound type, all other treatments using skin substitutes are deemed unproven and not medically necessary, according to coverage documents.
Does Humana Cover Skin Substitute Grafts?
Humana typically doesn’t cover skin substitute grafts for chronic wounds.
The company routinely denies Q-codes related to grafts, following similar guidelines to UHC and other commercial providers, according to their coverage documents.
Does Aetna Cover Skin Substitute Grafts?
Aetna allows coverage of certain skin and soft tissue substitute products, but only under specific criteria outlined above. According to Aetna’s Clinical Policy Bulletin 0244 (Skin and Soft Tissue Substitutes), eligibility requires photographic documentation (with a ruler), evidence that the wound isn’t improving under standard care, and any measurable changes every 14 days in wound characteristics like size, drainage, and granulation tissue.
Aetna could cover treatments with skin substitutes for diabetic foot ulcers and venous leg ulcers after conservative treatment has failed, but they also describe skin substitutes as “experimental, investigational or unproven.”
Does Anthem / Blue Cross Blue Shield Cover Skin Substitute Grafts?
Blue Cross Blue Shield officials say their plans generally cover skin substitutes for chronic, non-infected diabetic foot ulcers and venous leg ulcers that haven’t improved after at least four weeks of standard care. Coverage is limited, though, to approved products, like Apligraf®, Dermagraft®, and Theraskin®).
Transparently, Rebirth Advanced Healing hasn’t had any approved Anthem/BCBS claims for grafts.
What Happens if Coverage is Denied?
Despite commercial providers’ hesitancy to cover skin substitute grafts for chronic wounds, we will always run a patient’s insurance to verify benefits and determine if there’s any coverage.
If coverage is denied or a patient’s out-of-pocket cost would be significant, we explain that up front and typically pause treatment. We never begin treatment without a patient’s permission, and only move forward once they fully understand their financial responsibility.
Private Insurance Coverage Is Evolving. We’re Here to Help.
As more studies around the use of skin substitutes for chronic wounds become available, commercial plans could be more willing to cover those treatments. That’s because, in the long run, the higher up-front cost is actually cheaper than alternatives: Being stuck in a cycle of non-healing at a wound clinic, amputation, or worse.
If you or a loved one are interested in learning if advanced wound care is the right treatment for you, fill out our referral form.
Disclaimer: This blog is for general information only. It is not medical advice and does not determine or advise on benefits coverage. For medical concerns, talk to a healthcare provider. For benefits questions, contact the appropriate agency or your insurer.
