WOW! James...thanks to you and your friend for all that info. i like how he/she makes a bold point to add NO BACKING DOWN...Not letting insurance companies push us around. Just wanted to add Thanks!

Just a little something to update this post string and show that insurance companies DO pay for this when all is in order(or you beat them up well enough).

11-15-2004

Hope that someone can help me with this!

I have a question that needs to be addressed and I am sure that this situation will become more prevalent in the future.

I have a client with PCOS, who has petitioned her health insurance for coverage of electrolysis treatments. She does have a letter from her OBGYN stating that electrolysis treatments are nessessary for a hirsute problem due to the PCOS. She has been given approval for the treatments.

I have never dealt with an insurance company in this manner and would like to know if someone has and what should I expect. Are there any speacial forms that I should have or get from this client? Do I ask for payment up front and have her get reimbursed herself?

Any help would be greatly appreciated!!
Electrologist A
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11-19-2004
I dealt with this several years ago when there were third party payments.

At that time I did get paid and requested the insurance company send the check to the client. If they sent it to me in error I signed it over to them
I don't know if they work the same today
Electrologist B
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11-20-2004

Thank You for writing back. I just found out today that the insurance company will be paying me directly. The insurance company gave me an authorization number for her treatments. They have approved my client for treatments for the next to two months then I will reevaluate and submit another request for more appointments. I was very up front about not being able to give a set amount of appointments, when dealing with a case of PCOS. They didn't have a problem with it. I must say that it really wasn't as bad as I thought it would be.

There are a lot of women out there that would come if they were covered by their insurance company. I have a second client who I had go to her OBGYN this week also to request treatment. If there is a diagnosis of PCOS, there should be no question what so ever about electrolysis treatments. I think the insurance companys would rather pay us then someone who is doing laser. Besides, we have 129 years standing behind us, that should stand for something!
Electrologist A

Just keeping the info you need if you are reading this post string in this post string...
This was posted by Harvey Grove in the PCOS forum:

Quote:

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When females grow hair on surfaces where females usually do not grow hair but males always grow hair this is NOT COSMETIC. It is called a “male pattern distribution”....it is part of a potentially serious disorder (depending on the degree of severity of your case...mild, moderate or severe). PCOS can include infertility, adult acne, hirsutism (hair), obesity (due to insulin resistance with diabetes), cessation of menses which means the patient will develop a HYPERPLASTIC ENDOMETRIUM (this is an overgrown lining of the uterus and is recognized as a precursor to cancer of the uterus unless treated). Do NOT STOP TAKING YOUR MEDICATION UNLESS YOU TELL YOUR DOC FIRST.

There is an over-riding principle in law called “industry precedent”. It means “if one company pays ....they ALL HAVE TO PAY”. I have been paid many times by insurance companies and have photo copies of all the checks to prove it. The most was $4,280.00 by Tufts HMO. No lawyer was needed. These companies know no lawyer will take a case for less than $50,00.00 because they take a lot of time and our cases do not reach this level. We are a society of “screwers and screwees” (these are the legal terms) and insurance companies know how to use the system to delay and deny you your legal rights. Laws are made by lawyers, for lawyers, with no consideration for anyone else.

Some states have consumer laws that allow treble damages PLUS legal fees. This makes the companies take notice. You may have to pay for treatment but take them to court in the middle of treatment because small claims court has a limit on the amount of money you can sue for.Then you will continue treatment to get the rest of your money as you have established you have a legitimate claim. Anyone who changes companies to get paid by another company is making a big mistake as they can claim it is a preexisting condition and refuse to pay. They have access to your medical records and the doctors and treatments you had and that will destroy your chances of getting reimbursed.

Electrology is the “current standard medical practice” for this condition (remember this phrase as it is very important). Hair or HIRSUTISM is not a cosmetic problem....it is only one of a possible 10 symptoms of this condition. It is listed in all the medical texts of endocrinology and EPILATION therapy is reimbursed if the doctor prescribes it and he will do this if you ask him to write a letter that “epilation therapy is medically neccessary”. They do this all the time and the medical insurance code for this is Diagnosis (Dx 704.3) and Prescription (Rx 17380). The first is “hirsutism” and the prescription is the second, Electrolysis. These are the insurance codes used internationally and your doc has a code book to look it up to verify this. The code was invented by the WHO (World Health Organization).
You can contact me directly if you need more help at ..... <leftygg@verizon.net>.
Good luck .

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I'm fighting my insurance company using the suggestions here. Right now I'm getting ready to file my second appeal. I'd like to know if a person getting state-provided insurance has the same chances, or is it going to be more difficult?

wow that is alot to go through

it seems very difficult, does the same go for laser hair removal?

my obgyn has put a laser hair removal practice in his office... my doctors just don't want to hear about insurance.
i have oxford health care, can anyone recommend a more helpful doctor to assist with this in the ny area?

It is easier for insurance companies to deny LASER work since it currently is listed with the FDA as something other than Permanent Hair Removal. On the other hand, since a doctor is more likely to be performing LASER, someone getting LASER from a doctor frequently finds a more co-operative doctor. After all, he is submitting paperwork so that HE/SHE can get paid!

In a fight with the insurance company, you will most likely loose if your proposal is LASER, however, because they have the fact that it had not proven to be Permanent Hair Removal. That doesn't mean that they won't give you hell when you switch your request to Electrolysis, but you at least won't have the Permanent Hair Removal vs Permanent Hair Reduction agrument going in their favor.

It doesn't matter who your insurance is with, the same laws apply. Of course, in the US the government programs are more likely to ignore rules because they don't care about having to pay damages in law suits. In the worst case situation, they just raise taxes to cover the loss.

It is however a fact, precedent has been set, and if one has paid, they all must pay and it is a breach of promise if they don't.

James.... what can i say !!! THANK YOU FOR ALL THAT INFORMATION.

It's wonderfully useful, and i will start the process today. I was already thinking about how i should do this as i am not a person that is afraid of asking for what is rightfully due to me. i have fought many battles with insurance companies and other consumer companies..

anyway, the point of my post was to encourage people who might not belive that they can get their electrolysis covered.

i was approved by my insurance for my ear surgery which was totally a plastic surgery and i had no intention of collection coverage for it. i paid out of pocked and the doctor called me one day to tell me that, unexpectedly so, the insurance had approved the routine claim that his office files for every procedure. he did not believe it either, but they approved it b/c it was a "genetic defect which affected the quality of my life".

Right now, I get my EMLA with a prescription, and i will ask my OBGYN to write a letter stating that he prescribes the electrolysis treatment as part of my hormonal treatment (I do have a hormonal imbalance which causes infertility at the moment and the insurance of course covers all aspects of that treatment, so this will go right along with it). i am certain that it will work as long as the doctor is willing to write the letter.

Edited from James' suggestions and information. My OBGYN will submit the following letter:



To Whom It May Concern:

I have prescribed electrolysis (procedure 17380) for my patient, Ms. I.N., as treatment of her hirsutism (diagnosis 704.3) resulting from hyperprolactinemia.

The electrolysis procedure is an essential element of this patient’s treatment. Other treatments already covered by her plan include: Levlin28 (contraceptive pill), bi-yearly MRIs, Bromocriptine, Dostinex, adult acne medication, and potentially infertility treatments.

The electrolysis procedure was prescribed for the following reasons:

- The hair growth was caused by a diagnosable and treatable medical disorder

- Permanent removal of hair is necessary to restore the patient’s normal condition

- The electrolysis procedure is diagnostic as a physician can measure the effectiveness of the medication by monitoring the presence or absence of new hair growth. Electrolysis is therefore instrumental in establishing the most effective dose of medication.

- Electrolysis is the standard current medical practice and is the only permanent treatment for hirsutism resulting from this condition.

- To achieve maximum benefits for the patient with Hirsutism it is necessary to include electrolysis of the follicle alongside medical therapy or else the patient is denied the full benefit of the current body of medical knowledge regarding treatment of her condition. Also, it is unethical for a physician to withhold any information from a patient that the physician knows to be effective.

- There are multiple industry precedents for coverage of this procedure.

The professional treating this patient is a certified member of the Pennsylvania Electrologist Association, and has treated many patients under the instructions and in collaboration with other physicians. His contact information is as follows:

Mr. Michael Buonomo
Savarese Electrolysis
1315 Walnut Street, Suite 717
Philadelphia, PA 19107
215.735.8144

Please contact me if I can be of further assistance



Yours truly
C.C., M.D.


I wanted to post it to make is easier and faster for more of us to get the rpocess going.

Ivelina,

This a fantastic letter! Please keep me informed of the outcome. Unfortunately, I have not had a patient/client who has been succesful in getting approval for insurance in many years. I will keep my fingers crossed for you and everybody else who can certainly benefit from this. Also, a big thank you to James for bringing so much attention to this much needed topic.

Yes, I will let you guys know what happens.