How to get insurance coverage for vitiligo treatments?
Most of health insurance companies will initially reject claims for vitiligo doctor visits or phototherapy treatments but with enough efforts you can have a substantial part of related expenses covered by insurance.
Have your dermatologist write a letter to the insurance company. Your doctor should explain heavy psychological effects and socio-ecomonic burden of vitiligo, like a substantial loss of income because of regular phototherapy sessions during clinic's regular working hours or missed school time. It should also mention the risks of vitiligo, such as serious sunburn.
Send your personal letter to the health insurance approval department, explaining the devastating effects of vitiligo on your life. You could emphasize the same aspects as your doctor but from a more personal point of view. Explain how it has affected you socially and emotionally and mention any occasion in which your may have suffered from sunburn, if this has been the case. Follow up with phone calls and any supporting evidence.
A Medicare rebate applies to a percentage of the consultation cost, please ask your physician for a referral to a dermatologist. Narrow band phototherapy is fully covered by Medicare with no additional costs to the patient.
Insurance companies have defined each disease by a diagnosis code. Mention the ICD-9 code 709.01 when you call or write to them in order to speed up the process. Phototherapy or Light Therapy is a service billed to insurance with one of these codes:
- 96910 code for Narrowband UVB treatment, or
- 96920/96921/96922 codes for Excimer laser treatment.
Most insurance companies will eventually provide you with coverage for narrow-band (NB-UVB) phototherapy for vitiligo (however, not for laser therapy.)
Updated on April 26, 2016: GHI and HIP insurances are no longer reimbursing costs of phototherapy. However, Emblem Health (including GHI and HIP) will consider on a case-by-case basis reimbursement for "excimer laser treatment confined to areas of the face, neck or hands only”, with an additional caveat of "documented failure of adherent 3-month trial of both: i. high-potency (Class II steroids) ii. Protopic." (details)
Global health insurance company CIGNA no longer provides reimbursement for ANY phototherapy or laser treatments for vitiligo because "such treatment is considered cosmetic and not medically necessary" (details).
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