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-   -   Do insurance companies pay for laser treatments? (http://birthmark.org/board/showthread.php?t=1604)

Annicamer 09-25-2005 01:06 AM

Do insurance companies pay for laser treatments?
 
Hi, I am new to this website. I am 24 years old and have a pws on my face, neck and parts of my chest. When I was 11 years old I had a series of 6 candella laser treatments but discontinued the treatments b/c I developed asthma and could no longer be put under general anesthesia. I remember my MD telling my mother that I should have the treatments done before I was 18 years old so that insurance would cover it (afterwords it would be considered "cosmetic"). I am wondering if this is true. Obviously, all insurance companies differ, but in general do most adults have to pay out of pocket for treatments? My pws is superficial and I would really like to resume treatment but money is certainly an issue. Have any of you had any luck in getting your insurance companies to pick up all or even part of the bill?

juliemn 09-25-2005 04:19 AM

Re: Do insurance companies pay for laser treatments?
 
Many people have no problem obtaining insurance coverage for laser treatment.* Unfortunately, many others do have to fight to get coverage.* I, myself have not had to appeal for coverage of laser treatment as I live in Minnesota.* Here it is a state mandate that laser treatment for PWS be covered by insurance.*

I know that it is important that the doctor you choose considers your treatment a medical necessity rather than a cosmetic procedure.* If you have problems there are several great appeal letters posted here and on a couple of other sites that emphasize the medical necessity of laser treatment for PWS..i.e. thickening, blebs, hypertrophy, bleeding, etc.* Usually the appeal letters that they post for your reference are ones that have been successful.

PWS IS definitely a medical condition....not cosmetic.* The laser treatments do benefit the cosmetic appearance of the birthmark, but they first and foremost help delay the medical side effects of the birthmark.* Now...if we could just make ALL the insurance companies go for that.* ::)

Sorry I couldn't be more help.* I'm sure someone who's had to appeal their insurance company will chime in with specifics.

Welcome!

Sites with appeal letters besides the ones posted here:

Birthmarks.com
MSN Vascular Birthmark Support

edited for spelling..jh

hankbartenbach 09-25-2005 02:42 PM

Re: Do insurance companies pay for laser treatments?
 
Hi I am 23 with facial PWS.

I have had Blue Cross Blue Shields my who life. They have so far covered the past 18 years of laser treatment.

The doctor was probably correct at the time but is not true now because of the number of people that are adults with PWS.

I totally agree with the last post. It really depends on your State, your insurance company, and the Doctor. The best way to make sure that your insurance company will cover your laser treatment is to have the doctor performing the treatment write a letter to the insurance company telling them that this is not cosmetic surgery, but nessesity.
Have it say that PWS can grow (which it can in some cases) and cause major health problems in the future.

If you have any more questions let me know. Also if you would like to send the insurance company a picture of me before plastic surgery and say this enlarging of the PWS could happen to you if not treated you can. You can get it off my website www.hankspws.com

Talk to you soon.

Hank


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