Rosacea/Insurance

There are still many insurance companies that refuse to cover Laser/IPL treatments because they view rosacea as a "cosmetic concern". Here are some simple steps taken by previous rosacea sufferers to get insurance to reimburse both fully or partly.

Ring up your insurer and ask if it will be covered. Even if your insurance company will cover the procedures, they usually require pre-certification outlining the number of treatments and type of laser. Prepare a submission outlying your rosacea symptoms and how they affect and limit your lifestyle. Get photos of your severe flushing so the insurance company can see what you are really dealing with. Include peer-reviewed articles photocopied from books or medical journals or printed from the Internet.

The following symptoms are viewed as cosmetic (less important): Papules, pustules, redness and visible telangiectasias. The following are not cosmetic (more important): Flushing, blushing, burning, itching, facial swelling and pain.

Other major points to include:

• A letter of medical necessity from a physician in your plan including the CPT code for the procedure. (It was 17108 in 2003)
• A list of all other remedies you have tried (antibiotics, prescription topicals, diet and lifestyle changes, etc)
• In your letter explain that when lasers are used for cosmetic purposes the settings are different than when treating rosacea.
• As of 2004 many Laser/IPL machines are approved by the Food and Drug Administration (FDA) of the United States.

• If it is not treated it will progress into more advances stages
• You may be able to stop taking current rosacea medications after the Laser/IPL treatments

Be persistent. Fax your request and then send it with signature verification of the recipient. Call in a few days to confirm receipt, find out when the review committee will be meeting, follow up the day after that and keep on top of your request. Document the names and dates of people you speak with, it may be beneficial if you need to appeal a rejection. If your claim is rejected, ask why your claim was rejected then refute those claims with evidence. Ask at one of the online support groups for help if you need it.

Sample Letter

Below is a sample letter that was used by Adam to convince his insurance company to provide full coverage.

Dear Committee Members:

My name is Adam. I am 19 years old. Dr. xxxxxx xxxxxxxx , M.D., my dermatologist, submitted a request for Photoderm device coverage to alleviate my disabling rosacea. Dr. xxxxxx's request on my behalf was denied based on your determination that this procedure would be a cosmetic one. I believe you have made a mistake.

I have a tentative appointment set up to have my first Photoderm treatment on December 6, 2001 at Dr. xxxxxx's (different doc, this is the one who im actually getting the procedures done by) Office based on your decision after reading this letter. I am not doing this for cosmetic reasons - I am doing this for reasons that are medically necessary. My Rosacea is accompanied by severe flushing, swelling, inflammation, and worst of all a disabling burning pain. My condition is worsened by almost everything imaginable. Most foods, sun exposure, hot weather, warm rooms, cold weather, wind, humidity, exercise, embarrassment, anger, mental concentration, stress, facial movements such as chewing and smiling, certain medications, most topicals, lotions, sunscreens, soaps, cleansers, showering, shaving, daily physical activities (walking up a flight of stairs), cuddling up with someone, my head touching my pillow, and the heat from talking on the phone, are just SOME of the things that I run into each and every day that cause my facial pain to get substantially worse.

I have tried numerous creams, lotions and oral medications in an effort to alleviate the severe discomfort caused by my facial rosacea. The cost before insurance of all the prescription medications I have used in connection with my condition since the beginning of this calendar year totals over $2,500. In recent weeks I have begun experimenting with different antihistamines in an attempt to reduce the swelling, inflammation, and pain associated with the majority of foods I eat. This has not helped much, and I will soon be looking into adding a Cox-2 inhibitor such as Celebrex into my daily regimen.

The physical pain I live with every day, which is worsened by almost any movement I make, has become extremely debilitating. This disabling pain has caused me to become very depressed. My condition impairs my ability to function normally in society. I am unable to work, and have come close to dropping out of school more than once. I need to be able to get rid of the pain I live with every day so that I will be able to function normally once again.

This condition continues to be extremely costly for all parties involved. The insurance portion alone of the payment for the Psychiatrist I have begun seeing as a result of the depression this pain causes me, is $160 every month. Additional costs include doctor and dermatologist visits that I have needed as a result of my condition. In addition, I have already gone through one month of outpatient hospitalization at a substantial cost, because of the depression my Rosacea has caused me. By eliminating the need for most of these, five to ten treatments with Photoderm (which would cost a total of $1200-$1950) would be substantially less expensive than my current course of therapy has been. Payment for these five to ten treatments would be an extreme hardship for me, as my condition leaves me unable to seek employment. I have also begun to develop early-stage Rhynophymia as a direct result of my Rosacea, which if left untreated may eventually require an even more costly medically necessary surgery. Photoderm will prevent this aspect of my condition from getting worse, eliminating the possible need for more costly surgery in the future. It is important to remember that Rosacea is a progressive disease. Every symptom I have mentioned will more than likely continue to become more and more debilitating in the future without proper treatment.

My condition and the constant, debilitating pain it causes has left me unable to work. Since developing this condition I have been unable to maintain a steady job. The pain caused by simply placing my face against my pillow at night has left me unable to sleep properly. I usually am finally able to fall asleep around 4 A.M. with the help of powerful prescription sleep aids such as Ambien. Basically, my condition has left me unable to live a normal life. As you may or may not know, Photoderm has many different settings associated with it. The shallow filters are used to remove superficial, cosmetic redness from a person's skin. These are used for many cosmetic procedures. The deeper filters, which the doctor who would be performing the procedure has assured me will be used almost exclusively in my treatment, can be used to treat the underlying vascular reactivity, permanently decreasing my facial swelling, inflammation, and burning. This is why I require treatment with Photoderm.

I am asking you to please reconsider your decision. I am not having these treatments done for cosmetic reasons. I am having these treatments done because nothing else has worked. In my case, this is anything BUT a cosmetic problem. I have submitted supporting documentation from Dr. xxxxxx (my derm) with my request that you reconsider your original determination. Thank you for your review."