insurance coverage

l913 · #1 10-30-2004, 03:25 AM

I was wondering if anyone has ever gotten insurance to pay for laser treatments as an adult? I just recently had an appt. with a dermatologist to begin treatments again at the age of 26 and she said it is highly unlikely that insurance wil pay for an adult's treatment. Has anyone had any luck with this? Also, she does not recommend using EMLA cream for anesthesia of the site. She thinks she gets better results when not using it. Has anyone else heard this? I've never had treatments with the VBeam before and I'm afraid is going to hurt as much as the old pulse dye laser. Anyone have any suggestions or experiences to share concerning the VBeam regarding pain and bruising? I really appreciate the help.

hankbartenbach · #2 10-30-2004, 04:46 AM

Hi l913

My name is Hank,

I have answers for all of the questions that you have asked. I am 22 years old and I have personnally used the VBeam.

I have Blue Cross Blue Shields. They have covered my lasers for all fourteen years of treatments.
The secret is have your doctor write a letter to your insurance company explaining why the laser treatment you are wanting is not cosmetic surgery, and if not treated it can eventully grow and cause bodily harm.
She would not be lying either, because in some cases it does cause harm to breathing, eye site, earing or even eating. If your doctor still has dought, you can buy a copy from me of Geoff's surgery on the Discovery Channal. It pretty much shows how bad PWS can really get. His was so out of control the bone of his check was streching with his face.

The V-Beam is a very good laser, it is even safe on infants. I know exactly what dye laser you are talking about and no this laser is nothing like it. I do now how deep your PWS is so I can not tell you how well it will work, but it is very effective. It helped me in the lighter areas on my PWS. The reason she does not like the EMLA is because unlike the old laser you have used, it is not a single eraser size zap each time, it is more like the size of a nickel or quarter. It has a self cooling device that fans out like a squrt bottal but penatrats like an air compresser guess of air. With the EMLA it is not as effective.

Unlike the old laser when I got a local or put under for I take the zaps cold. It really does not at all snap yourself with a rubber band, that is what it feels like.
I have a large area on my face and with the old laser it would take 30 to 60 minutes, with this laser less the 10
It goes so fast I just sit on the table and look up and say done already? It has never bruised, and the stinging wheres off in about an hour.
The best part is you can get it wet all you like and you will have no problems. I even go by myself driving there and back an hour.

If you have any other questions please ask.
You can also email me and we can talk share storys.

Talk to you soon.

Hank

nickbar · #3 10-30-2004, 05:56 AM

I would encourage you to fight fight fight for coverage. Ask your doctor how he writes up the chart notes and ask about "medical necessity"... it is up to the doctor to understand that PWS are a medical condition that need tx. if left untreated more damaging issues can occur. this is not cosmetic! APPEAL the insurance denials... you can do this. If you go to the MSN support group there are some examples of insurance letters and information that helped the parents win with insurance appeals...or upfront approval. Don't take the first NO...that is what the insurance co. want...

Corinne

l913 · #4 10-31-2004, 01:18 AM

Thank you for the information. I'm not sure what the doctor will put in the letter to the insurance company. She said she will give me a copy but she did not sound optimistic. I will definetly fight if they deny but as of right now should I be doing anything? I just saw the doctor on Thursday and she said to give it a month. Any suggestions in the meantime. Thanks Hank for the info on the VBeam. This discussion forum is wonderful.

hankbartenbach · #5 11-02-2004, 04:29 AM

Take some detailed pictures of your PWS to keep on had incase the Insurance company says that you want the treatment for cosmetic surgery.

Tell the doctor that she needs to explain to the insurance company why you need this covered by insurance. If she is not willing to do this then you should find a different doctor. Dr. Waner from NY is a very good doctor. He is going to do surgery on me in Jan or Feb.

Hank

Lisa_99 · #6 11-10-2004, 09:12 PM

HI~

well we've had luck with my daughters treatments being covered, it's all the way the CPT codes are sent into the insurance company.

Lisa