Tips for Insurance Reimbursement
Experience has shown that most employee health insurance companies will cover some or all of the cost of home UVB phototherapy equipment; however, often this requires considerable persistence by the applicant.
To have the best chance of reimbursement, our suggestions are:
1. Obtain Solarc’s Standard Information Package (SIP) for home phototherapy or download individual files from the Download Centre. We suggest at least two (2) copies; one for your insurance company and one for your records. A third copy may be useful to leave with your physician. If you are having trouble downloading, give us a call or use the Contact Us page to request that an information package be mailed to you. We will make sure you get what you need.
2. Although a physician’s prescription is not required to purchase a phototherapy device or make a medical expense claim on your Canadian income taxes, a prescription may be useful when applying for coverage to an employer’s health insurance plan. If your physician is reluctant to write a prescription, to release them from liability, consider providing them with a signed copy of the “Acknowledgement and Indemnity Agreement” located on the last page of the Solarc Order Form. On request, Solarc can provide the physician any additional info required, such as a SolRx User’s Manual.
3. Supply your physician with a copy of our Doctor’s Letter of Medical Necessity and ask if they have time to create a personalized version of this for you on their stationery, or have them simply fill in the blanks in the form. There may be a cost for this. You may wish to provide your physician with the above editable MS-Word (.doc) file for their convenience.
4. If you cannot get your physician to create the Letter of Medical Necessity, we recommend that you write your own personalized letter to your company’s human resources department or insurance company using our Patient’s Letter to Insurance Company template, which is an editable MS-Word (.doc) file that you can easily personalize. This is your opportunity to make a “business case” for acquiring the equipment. In other words, based on your usage of drugs and other costs, will the equipment pay for itself? To support your case, include a copy of the medical study: “Are Narrow-band Ultraviolet B Home Units a Viable Option for Continuous or Maintenance Therapy of Photoresponsive Skin Diseases?” (pdf)
5. Talk to your human resources or insurer contact person about your request and present them with copies of your prescription, Letter of Medical Necessity, and all of the information literature. Ask for their help with your request. Contact Solarc if your insurer requires submission of an invoice before they will consider coverage (Proforma invoice).
6. Depending on the insurance company, the first response to your request may be that the equipment is not covered. The reason for this is that the first line contact person is normally only supplied with a list of commonly insured equipment, and UVB phototherapy equipment is often not listed. It might be helpful to mention that home phototherapy equipment is on the list of medical expense tax credit eligible expenses. See: Income Tax Act, Medical Tax Credit, 118.2(2)(i)
Insurance company considerations:
After surveying hundreds of our Canadian home phototherapy customers over many years, we have consistent documented evidence that, with respect to the large Canadian health insurance companies coverage of Solarc’s medical UVB home phototherapy equipment:
• MANULIFE almost always provides health insurance coverage for the purchase;
• COUGHLIN almost always provides health insurance coverage for the purchase;
• DESJARDINS almost always provides health insurance coverage for the purchase;
• BLUE CROSS sometimes provides health insurance coverage for the purchase;
• GREAT WEST LIFE sometimes provides health insurance coverage for the purchase;
• SUNLIFE almost never provides health insurance coverage for the purchase (ironic considering their name).
It is economically sensible for the health insurance companies to cover the devices because they have been proven to be very cost effective. Use of topical creams and ointments is typically greatly reduced (which at $230 for a single tube of Dovobet® can cost thousands of dollars per year), and UVB-NB phototherapy can keep patients away from the new biologic drugs, which cost $20,000 to $30,000 per year. To boot, UVB home phototherapy reduces the number of patients that must attend government paid phototherapy clinics, of which there are about 100 in Canada.
At this point, talk to your contact person again, and politely ask that your request be forwarded to a more senior representative. Try to talk directly with this more senior person. Some insurance companies will have an “appeal” process. Many people have made successful appeals.
Here is the key: Be persistent with your request and ask that it be referred even higher up if necessary. Be patient and always polite. At some point the answer may be a definitive “no”, but in many cases, the Insurer will comply. Your persistence shows that this is very important to you and that you truly need the device. Once approved, and just in case there is a change in personnel at the insurance company, try to get the insurer’s commitment in writing…Good Luck!