Many health insurance
companies will reimburse all or a portion of the cost of a light
therapy
device if proper diagnosis for seasonal depression/seasonal affective
disorder
has been made by a qualified health professional. The following sample
letter has been prepared to assist you in requesting reimbursement. The
letter must be written and signed by your doctor.
Individual health insurance policies sometimes vary significantly within the same insurance company. Your ability to get reimbursed, and the percentage of coverage if you are eligible, depends not only on your insurance company, but also upon the specific terms of your individual health insurance policy.
If in doubt, contact a
representative
of your health insurance company for additional information.
SAMPLE LETTER
Patient's Name:_______________________________________________
Health Insurance Company/Plan:_________________________________
Patient's Identification Number:__________________________________
Patient's Date of
Birth:_________________________________________
Description of Photo Therapy Unit:
This is to certify that I am presently treating the above named patient for recurring major depressions (DSMIV-R-296.3) with a seasonal pattern. This condition, known as Seasonal Affective Disorder, has been shown in many studies in the United States and Europe to respond to treatment with environmental light (photo therapy). Photo therapy is no longer considered experimental; it is a mainstream psychiatric treatment as described in the Task Force Report of the American Psychiatric Association: Treatment of Psychiatric Disorders, vol. 3, pages 1890-1896.
In the above patient's case, Seasonal Affective Disorder appears
__ to be an isolated psychiatric disorder.
or
__ to coexist with a previously diagnosed psychiatric disorder of other origins with photo therapy being an addition to other extant treatments.
In order to administer photo therapy adequately, a specialized lighting device, such as the one described with the attached invoice, is required. In this patient's case, the use of such a device should be regarded as both a medical necessity and a preferred method of treatment for this disorder. Treatment necessarily requires use at specific time of day and duration. Therefore, the patient's possession of a home-use unit such as has been prescribed is a requirement for successful and practical therapy, and in my opinion, is the most cost effective treatment procedure.
Code # and Diagnosis
DSM IV-296.3X - Major
Depression,
Recurrent
DSM IV-296.4X - Bipolar
Disorder, most recent episode- Manic
DSM IV-296.5X - Bipolar
Disorder, Depressed
DSM IV-296.6X - Bipolar
Disorder, Mixed
DSM IV-296.8 - Bipolar
Disorder,
NOS
DSM IV-311.00 - Depressive
Disorder, NOS
These procedures conform
to April 1993 U.S. Public Health Service Agency for Health Care Policy
and research guidelines for management of this disorder.
Publication # and Title
AHCPR93-0551 - Depress:
Guideline Vol. 2
AHCPR93-0553 - Depress:
Patient Guide
__________________________________
_______________________
Prescribing
Doctor
Date
__________________________________
Practice ldentification Number
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