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#1366 - 08/14/03 07:09 AM does insurance ever pay for electrolysis? *****
Carol Nurse Offline
Member

Registered: 07/07/03
Posts: 11
I have a friend who has had most of her electrolysis reimbursed by her husband's company insurance policy. My insurance company says no way. Are there any insurance companies that cover electrolysis?

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#1367 - 08/14/03 07:46 AM Re: does insurance ever pay for electrolysis?
James W. Walker VII Offline

Top 10 Contributor

Registered: 06/03/02
Posts: 7997
Loc: Buffalo NY, & Traveling the US...
All Insurance companies must cover electrolysis when prescribed by a doctor. Where they differ is how much trouble they put the insured through before they pay up.

Some will only reimburse, others will pay the doctor, who pays the electrologist, and still others will cut a check directly to the electrologist.

Keep in mind that if you are being treated for a hormonal imbalance, electrolysis is necessary to completely reverse the effects of that imbalance. The drugs may restore the chemical composition of your system internally, but you need electrolysis to remove the outward expression of that period of imbalance outwardly. Some medications your doctor prescribes will also have unwanted hair growth as a side effect. Many birth control pills have this problem. Attending to this side effect should be a part of your treatment program up front. Of course, only you will ever bring this up, so make sure that you take your medical care proactively and get all that you have got coming to you.

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#1368 - 09/02/03 12:51 AM Re: does insurance ever pay for electrolysis?
victoria Offline
Member

Registered: 09/01/03
Posts: 23
my doctor says, they never pay for it since it is considered cosmetic... is she wrong? I am 16 and have ridiculous amount of facial hair, and most likely have a hormone imbalance. is there anyway I can get my insurance to pay for it?

quote:
Originally posted by James W. Walker VII, CPE:
All Insurance companies must cover electrolysis when prescribed by a doctor. Where they differ is how much trouble they put the insured through before the pay up.

Some will only reimburse, others will pay the doctor, who pays the electrologist, and still overs will cut a check directly to the electrologist.

Keep in mind that if you are being treated for a hormonal imbalance, electrolysis is necessary to completely reverse the effects of that imbalance. The drugs may restore the chemical composition of your system internally, but you need electrolysis to remove the outward expression of that peroid of imbalance outwardly. Some medications your doctor prescribes will also have unwanted hair growth as a side effect. Many birth control pills have this problem. Attending to this side effect should be a part of your treatment program up front. Of course, only you will ever bring this up, so make sure that you take your medical care proactively and get all that you have got coming to you.


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#1369 - 09/02/03 04:04 AM Re: does insurance ever pay for electrolysis?
James W. Walker VII Offline

Top 10 Contributor

Registered: 06/03/02
Posts: 7997
Loc: Buffalo NY, & Traveling the US...
You need a doctor who will co-operate with you, but you can get it done. If your hair problem is related to any medical condition, then treating it is a part of treating your over all condition.

When you have a doctor who does not take it seriously enough to prescribe treatment for you, then you won't get co-operation from the insurance company either. Just keep in mind that doctors get paid bonuses to help insurance companies keep their costs down.

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#1370 - 09/19/03 01:32 AM Re: does insurance ever pay for electrolysis?
yb Offline

Top 10 Contributor

Registered: 02/03/03
Posts: 392
Loc: New York, NY
I am also trying to get coverage for electrolysis. I have a letter from the doc, and currently I'm being given a little run around. But that's ok so far. It seems very logical that they'll have to pay to treat this medical condition like any other.
I could basically think of all the answers to any claims that the insurance company could make. But I'm having trouble with the following hypothetical question:
They could claim that excess hair, although a symptom of a diagnosable and treatable disorder, is in itself a cosmetic side effect. For instance, birth controll pills are sometimes prescribed for PCOS, and even though are otherwise a convenience, they still have a theraputic effect for the condition. The pills stabilize hormone levels, releive symptoms (restore periods, for example) and prevent complications. Whereas, excess hair is only a cosmetic symptom. It in itself is not dangerous, it cannot cause any complications -- the only bad part about it is the 'looks'. This is only a cosmetic problem, and cosmetics are not covered by any insurence plan.

Does anyone have any ideas about it?

So far I can only think of a psychological effect on the patient. Then it becomes a symptom of a medical condition, which causes other complications. But in this case one might have to prove the psychological effect or be diagnosed for it. Granted, no woman is very happy with this symptom, but still this complicates matters.

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#1371 - 09/19/03 05:16 AM Re: does insurance ever pay for electrolysis?
yb Offline

Top 10 Contributor

Registered: 02/03/03
Posts: 392
Loc: New York, NY
(Continued...)
Another example is if someone gets a bad sunburn. The burn is a medical condition and will be covered by insurance plans. If afterwards the patient develops skin cancer it is also a medical condition which compromises the patient's health, and he'll be covered.
But if the after effects of the burn are hyperpigmentation or wrinkles or any other deterioration of the 'looks' of the skin, no insurance will pay for plastic surgeries to reverse these conditions. These are purely cosmetic concerns that have no effect on the patient's health, even though they are a result of a diagnosable and treatable disorder (sunburn) which itself is covered.

I didn't get yet as far as facing this claim from the insurance company, but hypothetically, can anyone think of a way to persuasively counter such a claim?

Thanks.

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#1372 - 09/29/03 05:46 PM Re: does insurance ever pay for electrolysis?
Kilimanjaro Offline
Member

Registered: 10/13/02
Posts: 22
Loc: Ohio
I would doubt that you can ever get insurance to pay for it.

I had a medical disorder that makes my feet sweat excessively and tried getting the drionic machine that improves this condition. The drionic.com website even mentions that insurance pays for it since it is a condition that causes medical discomfort - they gave me all the insurance codes for the device. However, my insurance company (which is generally very good) rejected the claim outright.

Body hair doesn't even cause physical discomfort - embarrassment is not a physical issue.

Also remember that body hair, especially for men, was not considered an unattractive thing just a couple of decades back. In the 70s, people actually liked to show of their chest hair! I think that most docs are middle-aged and don't realize the trends in physical appearance these days. They also see countless patients unable to afford basic medical coverage, and will more than likely laugh at you when you ask them for hair removal insurance coverage.

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#1373 - 09/30/03 07:23 AM Re: does insurance ever pay for electrolysis?
yb Offline

Top 10 Contributor

Registered: 02/03/03
Posts: 392
Loc: New York, NY
I am talking about a medical condition which causes lots of hair to grow in all the wrong places on a female.

Anyway, you might deserve insurance coverage. I don't know about your condition and if what you want covered is the industry standard to treat your condition, but if it is, you will need to fight for the coverage. No one likes to give money away, but if they legally must, and YOU MAKE them, then they will. (At least it makes sence to me [Smile]

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#1374 - 09/29/03 11:08 PM Re: does insurance ever pay for electrolysis?
James W. Walker VII Offline

Top 10 Contributor

Registered: 06/03/02
Posts: 7997
Loc: Buffalo NY, & Traveling the US...
Insurance companies are all about collecting premiums and never paying any claim they can avoid paying. Of the claims they do pay, they make sure to never pay anything any sooner than they have to. A good book to read on the insurance industry is "Invisible Bankers" by Andrew Tobias.

For something like this, you usually have to pursue them diligently, and be willing to file suit against them for either breach of promise, in large amounts, or in small claims court for small amounts.

Once your electrolysis costs reach $1,000.00 you are fully in line to take them to small claims court, and once you get the judgment, they will be more accommodating in future payments. They will tell you they lost your letter from the Doctor. It was never delivered. The worker who received your information no longer works there anymore and they don't know where she/he put your file. It is all a con!

I will post a letter here for your use in getting your treatment out of the insurance company some time soon. I don't have the time right now.

But in the matter of rationalizing why they don't have to pay, you need to understand that electrology is actually a part of the doctor's diagnostic treatment as well as returning you to your former state. How can the doctor evaluate the effectiveness of the medication you are using in turning back the continued growth of hair, if the previously grown hair is never removed?

In the case of your foot machine, they would/will pay if you file small claims case against them for reimbursement. They rely on people giving up if they put up a little resistence. They also know they can't win anything in an actual court (not binding arbitration, who do you think is paying the arbitor's salary?) because no judge and no jury has any sympathy for insurance companies. After all, finding a jury who has never had reason to have a grudge against one is just impossible.

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#1375 - 09/30/03 03:56 AM Re: does insurance ever pay for electrolysis?
James W. Walker VII Offline

Top 10 Contributor

Registered: 06/03/02
Posts: 7997
Loc: Buffalo NY, & Traveling the US...
Ok friends, this is going to be a book!

I asked my friend to post this, as it is his information, but since that has not happened since this post string started, I will add the information here myself.
--------------------------------------------------
First..... there is a legal principle involved here called “industry
precedent”. This means if one company in the industry pays....they all
have to pay. I have copies of letters from insurance companies that
rejected me and then paid me shortly afterward. They try to get out of
it by claiming we are not doctors or not licensed to do the procedure.
This usually works for them as the insured has no idea where to go from
here and many of the large states do not have licensing.

Insurance companies operate on the basis of two words.... DELAY and
DENY. They hope you will quit or die and that ends the case. They also
know no lawyer will take a case worth less than $50,000 as there is no
money in it for him, therefore, when they delay you it is a forgone
conclusion you will not sue them. If there are consumer protection
laws, as we have in Mass., that allow TREBLE DAMAGES PLUS ATTORNEY’s
FEES they hope you do not know about them but if you do know about
these laws they can always reverse their position and that will keep
you happy. A case in one of the Carolinas involved a girl with PCOS who
went to an Endocrinologist. She was told he could prescribe medication
but nothing was available to remove the hair except electrolysis and he
told her to find one and get treatment. She did what the doctor ordered
but the insurance company refused to pay. She sued and won. The
insurance company appealed and lost the appeal. The insurance company
took it to the state supreme court and argued the electrologist was not
a MEDICAL person. The court ruled, “ the doctor ordered it therefore it
was medical, no matter who did the work, as there is no licensing of
electrologists in that state”.

Insurance policies pay for DIAGNOSABLE AND TREATABLE DISORDERS. All
procedures and illnesses have a computer code for entry into the
computer. The code (called an ICD9 number) for the diagnosis of PCOS is
704.3 and the treatment is 17380. They will claim electrolysis is for
cosmetic purposes and they do not pay, however, the only cosmetic
procedures we do is eyebrows, underarms, and bikini lines. Everything
else is part of any one of a number of medical disorders. PCOS has
about 10 symptoms and if they are paying for the birth control pills
they have admitted the patient has a treatable disorder as there is no
medication for any cosmetic disorder.

Birth control pills are a CONVENIENCE for birth control. They are not
for a disease, however, in PCOS there is a hormone imbalance and the
hormones needed to restore the balance just happens to be in the birth
control pills or else the doctor can order the hormones separately and
it will cost more. Therefore the doctor has to write a letter stating
the medication is “medically necessary” and they will pay. This is a
routine procedure and they will pay to treat PCOS as it is common and
they know this. All doctors know about this and will write such a
letter. This is important as it establishes the patient has a treatable
condition for which medication has been prescribed.

Next.... AFTER you get a prescription reimbursed by the insurance Co.
you file for reimbursement of electrolysis treatments. They will still
maintain hair removal is cosmetic, however, too much hair in all the
wrong places is a medical problem and if needed visit a second doctor
to get a second opinion as they have to pay for this too. You will have
to appeal their decision and you have 3 appeals to go through. At the
third appeal you challenge them. NEVER SURRENDER THE POWER. MAKE THEM
KNOW YOU ARE NOT TAKING ANY NONSENSE and you will beat them in court
because of “industry precedent”. They have a contract to pay for all
diagnosable and treatable diseases and electrolysis is the “current
standard of medical treatment for this condition” (remember this
phrase...it is vital to your argument).

At the appeal ask the ombudsman who is usually running the show..... 1.
Are you a doctor?  2. Did you ever examine the patient ? 3. Would you
know what you were doing if you did examine the patient ? (If the
person running the show is a doctor..... ask if he/she is a specialist
in this disorder) 4. If they say it is “company policy” NOT TO PAY FOR
THIS, ask to see the company manual where this is stated. 5. Let them
know they are stating the Board Certified Doctors who made the
diagnosis are going to be notified the insurance company maintains the
doctors do not know what they are doing and they slandered these
doctors, therefore, you will tell the doctors and they will sue them
for enough money to enable them to BUY TAHITI not just retire to Tahiti
as they ruined their practice. In addition you will sue the ombudsman
for malfeasance AS THE INSURED IS PAYING HIS SALARY and he will have to
get his own lawyer as the insurance company will not pay for his
lawyer. (YOU HAVE TO TAKE THE OFFENSIVE. DO NOT LET THEM GET AWAY WITH
ANYTHING.....DO NOT SURRENDER THE POWER). it PROBABLY will not get to
this level, however, you now see you have a number of options.

I will send you some stuff written by a doctor who is also a lawyer
that is relevant to this. You will be surprised at what can be done. It
is probably worth it because the number of treatments can run into
thousands of dollars if she has a serious condition.

letter that gets the most response with the least hassle.
                                                                    
(may need some minor customizing for each case)
--------------------------------------------------                                                      MUST BE ON DOCTORS
LETTERHEAD

MEDICAL CLAIMS DEPARTMENT
XYZ INSURANCE CO.
CLAIMS DEPARTMENT / OR MANAGER

RE: (patient’s name) Policy No. #000000

Dear Ms./Mr...............

I have prescribed for my patient, Ms. .............., electrolysis
(procedure 17380) as a consequence of a hormonal imbalance resulting in
hirsutism (excessive and abnormal growth of hair in a distribution not
normal in a female... (diagnosis 704.1).

I am writing you to clarify the medical necessity of this treatment.

Hair removal is NOT cosmetic in these patients because

         A. a medical condition causes the hair growth.

        B. permanent removal of hair is necessary to restore the patient
to normal function.

        C. the physician can measure the effectiveness of medication by
monitoring the presence or absence of
            new hair growth in the areas involved only after
electrolysis therapy. Since no two patients respond
            in a similar manner to a given dose of any medication,
dosage MUST be individualized to
            minimize potential “side effects”. Electrolysis, therefore,
is instrumental in establishing the most
            effective dose of medication, consequently, the electrolysis
procedure is diagnostic as well as
            therapeutic.

        D. To achieve maximum benefits for the patient with Hirsutism it
is necessary to include electrolysis of
            the follicle concomitantly with medical therapy or else the
patient is denied the 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.

        E. Electrolysis is standard, current medical practice and is the
only permanent treatment for hirsutism in
            this medical condition and has been certified as medically
indicated and necessary by a disinterested
            physician, Dr. ...... , a Board Certified Endocrinologist
(or Gynecologist).

        F. There is industry precedent in Massachusetts and a number of
states for coverage of this procedure.

Please contact me if I can be of further assistance

Yours truly
XXXXXXX M.D.

--------------------------------------------------
Very important phrases............

1. A hormonal imbalance resulting in hirsutism (excessive and abnormal
hair growth not normal in a female 2. Is NOT COSMETIC in these
patients. 3. A medical condition causes the hair growth. 4. Permanent
removal is necessary to restore the patient to normal function. 5. the
physician can measure the effectiveness of medication by monitoring the
presence or absence of new hair growth ONLY AFTER electrolysis therapy.
6. no two patients respond in a similar manner to a given dose of any
medication.  7. dosage MUST be individualized to minimize potential
side effects. 8. Electrolysis, therefore, is instrumental in
establishing the most effective dose of medication. 9. the electrolysis
procedure is diagnostic as well as therapeutic (this is vital because
ALL DIAGNOSTIC TESTS ARE COVERED 100% IN VIRTUALLY ALL POLICIES). 10.
To achieve maximum benefits for the patient it is necessary to include
electrolysis. 11. or else the patient is denied the benefit of the
current body of medical knowledge regarding treatment 12. It is
unethical for the physician to withhold any information from a patient
that the physician knows to be effective. 13. Electrolysis is current
standard medical practice. 14. the only treatment for hirsutism in this
medical condition. 15. has been certified as medically necessary by a
disinterested physician (this means the physician has no vested
interest in electrology other than to see the patient get the most
effective treatment with no financial gain for the physician). 16.
there is industry precedent for coverage for this procedure (in law
they often resort to “precedent” so this VIP). In addition, read the
policy to see if there is any wording that refers to “diagnosable and
treatable disorders” which this is as opposed to a “cosmetic
procedure”. Electrolysis for cosmetic purposes would be limited to
eyebrows, underarms, bikini line, raising the hairline on the forehead.
All other areas could be part of a medical problem.

Do not let them push you around. Their tactics usually involve denying
and delaying all these claims. Send all correspondence by “return
receipt requested mail” so you will have proof the letter was sent and
received. Sometimes they claim they “lost” the letter but if you get no
reply send another with a note there will be more and it is doubtful if
they lose all correspondence. Lastly you can take them to small claims
court after about only $1000 of treatments. Ins companies do not want
to go to court under any circumstance as they know nobody likes them
and the penalties are usually severe. They will try to call your bluff
every time as the know no lawyer will take a case for less than $50,000
so they figure you will drop the whole thing due to frustration.

I hope this has been useful.

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