Insurance

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Some of our customers have been reimbursed by their insurance companies, with coverage usually ranging from 50% to as much as 100% coverage. Many others have had no luck getting any coverage, even after many appeals.

The issue of insurance coverage is complicated for many reasons. First, insurance companies vary greatly in classifying various treatments. Second, they vary their coverage from one policyholder to another, based on how the individual policies are written.

To date, the U.S. Food and Drug Administration (FDA) has not evaluated light therapy. Because of this, many insurance companies claim bright light treatment is experimental. However, many published studies support bright light treatment as a viable therapy, and in fact, it is the approved, mainstream treatment according to both the American Medical Association and the American Psychiatric Association.

To determine whether your health insurance policy covers light therapy devices, you will need to contact your insurance company directly and inquire. If they say that they will (or even 'may') cover a SunBox purchase, make sure you GET IT IN WRITING, and that you fully understand their procedure(s). Sometimes a claim is denied because our customer was overenthusiastic and ordered the product before obtaining either a prescription from their health professional (not required for purchase but may be required for the reimbursement claim) or the proper pre-approval from their insurance company. Unfortunately, you need to play by your insurance company's rules.

If you receive a noncommittal response and decide to take a chance on receiving reimbursement, you'll probably want to have your doctor write a letter on your behalf that resembles the following sample letter:

Sample Letter #1

For Insurance Company Reimbursement

To whom it may concern:(Insurance carrier)

This is to certify that (patient's name) is a patient of mine. (S)he is being treated for recurrent major depressions with a seasonal pattern.

Referral to "seasonal patterns of depression" has been included in the most recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Phototherapy is no longer considered experimental, but is a mainstream type of psychiatric treatment for Seasonal Affective Disorder (SAD). According to the December 8, 1993 issue of The Journal of the American Medical Association (JAMA), "For many patients with SAD, light therapy should be regarded as a first-line treatment, given its high success and acceptance rate" (Vol. 270, No. 22, pages 2717-2720). In 1989, the American Psychiatric Association's Task Force on Treatment of Psychiatric Disorders (Vol. 3, pages 1890-1896, A.P.A. Press), recommended light therapy as treatment for the range of clinical depression diagnoses including:

CODE NO. DIAGNOSIS

DSM IV-296.3x Major Depression, Recurrent

DSM IV-296.4x Bipolar Disorder, most recent episode-Manic

DSM IV-296.5x Bipolar Disorder, Depressed

DSM IV-296.6x Bipolar Disorder, Mixed DSM IV-296.8 Bipolar Disorder, NOS

DSM IV-311.00 Depressive Disorder, NOS

In order to administer phototherapy adequately, a bright light unit is required. In (patient's name)'s case, the use of the bright light unit should be regarded as a medical necessity and may be used in conjunction with other forms of treatment.

These procedures conform to April 1993 U.S. Public Health Service-Agency for Health Care Policy and Research guidelines for management of this disorder.

PUBLICATION # PUBLICATION TITLE

AHCPR93-0551 Depress: Guideline Vol. 2

AHCPR93-0553 Depress: Patient Guide

Sincerely,

(Prescribing doctor's signature)

If your claim is denied, it sometimes helps to have your doctor send a follow-up letter like the one that follows, and enclose with it several study reprints that support the efficacy of light therapy:

Sample Letter #2

For Insurance Company Reimbursement

Dear Sir/Madam:

I regret to see that you have rejected (patient's name)'s claim for a light fixture. Once again, I respectfully suggest that light therapy is not experimental. I refer you to a 1993 article in the Journal of the American Medical Association [1], discussing the successful treatment of seasonal affective disorder with light therapy, as well as to an article in Primary Psychiatry [2], explaining to psychiatrists how to go about using light therapy. The former of these journals is the major publication of a prestigious medical organization, and the latter is a journal distributed to general psychiatrists, keeping them up to date with new developments in psychiatry.

While I understand that there has been some controversy about light therapy in the past, as evidenced by a 1996 article in The Wall Street Journal [3] suggesting that light therapy may not be effective, this controversy has now been resolved to the satisfaction of all published researchers in the SAD and light therapy field. The new consensus is reflected in a subsequent 1998 article, also in The Wall Street Journal [4] in which this mainstream publication completely reversed its earlier skeptical stance and reported on the unanimity in the field as to the efficacy of this treatment.

I am aware that insurance companies are looking to cut costs wherever possible, but I would like to respectfully point out to you once again that a light fixture is a one-time expense that pays for itself many times over in the form of fewer doctor's visits, laboratory tests, and costly medications. I trust that this letter will suffice to enable (patient's name) to receive reimbursement for her legitimate medical claim.

Sincerely,

(Prescribing doctor's signature)

References:

[1] Rosenthal, NE (1993). Diagnosis and treatment of seasonal affective disorder. Journal of the American Medical Association, 270(22), 2717-2720.

[2] Rosenthal, NE (1994) Light therapy: theory and practice. Primary Psychiatry, Premier issue: 31-33.

[3] More people warm to simulated sunlight: but scientists doubt it cures winter blues. The Wall Street Journal, March 6, 1996, p. B1.

[4] New light on therapy for winter depression. The Wall Street Journal, December 15, 1997, p. B1.

If we can do anything to help you with your claim, please contact us.

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