Page 1 of 2 12 LastLast
Results 1 to 10 of 14

Thread: Insurance Question

  1. #1
    Senior Member cashisclay's Avatar
    Join Date
    Apr 2007
    Posts
    321

    Default Insurance Question

    I am going in for my first IPL tomorrow. I called my insurance company and it sounds like they are going to cover it. I need to get a letter of medical necessity from my doc and the diagnostic codes.

    I found a few diagnostic codes through the forum, but was wondering if anyone has more of them? For example, the code for burning and flushing.

    Thanks.
    "Tomorrow the sun will rise. Who knows what the tide could bring?"

  2. #2
    Senior Member
    Join Date
    May 2006
    Location
    new jersey
    Posts
    737
    Country: United States

    Default Insurance codes

    The ones I've been successful with are
    IDC-9 - 695.3 Rosacea
    CPT: 17106 Destruction of cutaneous vascular proliferation
    HCPCS: S8948 Application of a modality (requiring constant provider attendance) to one or more areas; low level laser each 15 minutes
    Good luck and keep us posted on your treatments
    Arlene

  3. #3
    Junior Member
    Join Date
    Dec 2007
    Location
    New Jersey
    Posts
    15

    Default Insurance

    I also had posted a similiar question recently.....can't say I have been successful in coverage but I am working on it.

    The only other code I know to add to Arlene's message that may be applicable (other than what was already mentioned) are:
    CPT 96999 unlisted special dermatological service or procedure
    (next to the one 96920 Laser treatment for inflammatory skin disease (psoriasis);...)

    I have Horizon Blue Cross Blue Shield of NJ. So, far I have gone through pre-certification (autorization)....for which they denied, so I will have to appeal. (I do have another problem in that the Dr. will not use these codes (Arlene mentioned) until I get authorization from HBCBS so my claims do not reflect this.)

    Good luck,
    Please let the group know how you make out.

    It would be nice to get info. on others experiences
    1) insurance carriers
    2) what they cover (using which codes)
    3) what process was taken (ie. authorization, appeal etc.)

    Maybe we can make a change to making insurance coverage a smoother process. Also, maybe one change has to occur at the AMA or American Board of Derm. level to add a CPT code more appropriate???

    Thanks,

  4. #4
    Senior Member cashisclay's Avatar
    Join Date
    Apr 2007
    Posts
    321

    Default Re: Insurance

    Quote Originally Posted by Crystal
    I have Horizon Blue Cross Blue Shield of NJ.
    I have the same. I guess I know what they are going to say to me. I will not stop fighting this though. I'm going to explain to them that we don't get this done for cosmetic reasons and it is a medical necessity. It will cost them way more in the long run in terms of derm visits, topicals, and psych treatments for denying me.
    "Tomorrow the sun will rise. Who knows what the tide could bring?"

  5. #5
    Senior Member
    Join Date
    May 2006
    Location
    new jersey
    Posts
    737
    Country: United States

    Default insurance

    I would advise any one with insurance to fight all the way. My insurance company (United) decided to deny coverage a while ago based on "experimental" procedure. I had to gather a number of studies (from pub med etc. ) in order to file an appeal. Fortunately my particular contract allows for an outside panel to review an appeal once it is rejected (mine was) by the insurance company. I won on the second step but they can deny each claim and put me through that every time. Fortunately, so far, they have not. I have friends who have lost appeals and taken the inurance company to small claims court and won.
    Some people think "this is not worth the trouble". I guess I'm just stubborn and I know this disease can wear you down but its time that insurance companies (and some stubborn doctors) understand the difference between someone who has a couple of veins on their face and people who are really suffering

  6. #6
    Senior Member cashisclay's Avatar
    Join Date
    Apr 2007
    Posts
    321

    Default Re: insurance

    Quote Originally Posted by arb161
    I guess I'm just stubborn and I know this disease can wear you down but its time that insurance companies (and some stubborn doctors) understand the difference between someone who has a couple of veins on their face and people who are really suffering
    That is my feeling. Rosacea has to viewed for what it is, which is a disease. It should get insurance coverage just like any other disease.
    "Tomorrow the sun will rise. Who knows what the tide could bring?"

  7. #7
    Senior Member
    Join Date
    Aug 2006
    Location
    USA
    Posts
    815

    Default

    I sure hope you get that coverage!! Love the fighting spirit here...and that spirit is what will make changes happen across the US in getting this horrible disease covered...and all treatments covered.
    Dx 1998

  8. #8
    Junior Member
    Join Date
    Dec 2007
    Location
    New Jersey
    Posts
    15

    Default

    Since we have the same insurance, I'd think it would play out the same...never know, but I will keep you posted on my progress.

    Totally agree on the refusal for others to recognize-disease, symptoms, medication all don't sound cosmetic! I am going to work the process til I know I tried my best.

    My status: Like you said, the authorization dept. denied since they consider IPL a cosmetic procedure. I need to appeal and will be gathering "articles", "testimonies" etc. to prove this. Any good suggestions others used to really prove the case? They said once I send this in they have a Dr. review & get back in 5 days.

    Other possiblities: Like the story above, I have heard that since the Ins. co. have internal reviews they continue to deny. I don't know if I have the option to have an "outside" review panel like mentioned above....but I was told you can also file a compliant to the State Insurance Department. This may not make a difference, but I heard in some cases Ins. Co. don't like to have public compliants filed on them.

    On a side note: Looks like we are all in NJ....maybe we could help even more with Dr. suggestions/locations & Stat Ins. Dept. info.

  9. #9
    Senior Member
    Join Date
    May 2006
    Location
    new jersey
    Posts
    737
    Country: United States

    Default insurance

    Google pub-med. Put rosacea in the search engine. On there you will find studies that doctors have done showing the efficacy of laser treatments. Also google laser and Rosacea- you will find other studies- some of these have just the abstract and some you will have to pay to get the full studies. I needed 2 full studies. Also go on line and get some hospital protocols for the treatment of rosacea- these should include laser. This shows that lasers are a standard treatment for Rosacea. I send this along with a letter describing my symptoms and the long list of "standard" treatments- creams, pills etc. that have failed
    Good luck
    Arlene

  10. #10
    Senior Member
    Join Date
    May 2006
    Location
    new jersey
    Posts
    737
    Country: United States

    Default insurance

    Just wanted to add- State insurance department is ineffective. If all else fails take them to court

Similar Threads

  1. Insurance Cover
    By Jason1984 in forum Intense pulsed light and laser
    Replies: 3
    Last Post: 2nd December 2008, 12:45 PM
  2. insurance
    By GracieTiger in forum General rosacea questions
    Replies: 3
    Last Post: 30th October 2008, 09:21 PM
  3. Medicare and Insurance
    By Quench in forum Oceania, Asia and Rest of World
    Replies: 3
    Last Post: 13th May 2007, 06:58 PM
  4. INSURANCE
    By Bonnie in forum General rosacea questions
    Replies: 1
    Last Post: 11th November 2005, 06:08 PM
  5. Q about insurance
    By tryingtogetoverit in forum General rosacea questions
    Replies: 3
    Last Post: 30th June 2005, 12:42 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •