Day-Light Therapy :: Insurance Coverage
Insurance Coverage
Many
private insurance companies recognize the benefits of light therapy and
its cost advantages over antidepressant medication, so they will cover
the purchase of a light box with a prescription from your doctor. In
fact, 65-70% of insurance companies have reimbursed the purchase price
of light boxes for the treatment of SAD, the winter blues and other
mood disorders, PMS, sleep disorders and when having difficulty
adapting to shift work.
Be
sure to first call your medical insurance company to see if they cover
the expense of a light box and to discuss specific documentation
requirements. Bright lights are not approved for reimbursement under
Medicare, and are available widely for purchase without a prescription.
Your chance of reimbursement is greatly improved if you submit the following to your insurance company:
- Letter with appropriate diagnostic criteria signed by your
doctor. (For instructions and a sample letter
- Prescription from your Doctor recommending 10,000 lux, duration and time of day to administer treatment.
- Receipt or invoice for purchase of light box.
Can You Get Insurance Coverage For Your Day-Light ?
Most private insurance companies help cover the cost
of a Light Therapy Lamp for those meeting the below diagnostic
criteria. See reverse for a sample prescription letter that can be
submitted to your insurance company, signed by either your Doctor or
Therapist. Remember that policies vary significantly among insurance
companies. Your ability to get reimbursed, and the percentage of
coverage for which you are eligible, depends not only on who your
insurance company is, but also upon the specific terms of your
individual policy. If in doubt, contact your insurance company for
further information before purchasing a light therapy lamp.
Diagnostic Criteria for
Seasonal Affective Disorder (SAD)
Your doctor may provide a SAD diagnosis if conditions
A through F are met under:
Major Depressive Disorder, Section 296.3x. from
Diagnostic and
Statistical Manual of Mental Disorders - Fourth Edition
(DSM-IV), published by the American
Psychiatric Ass., Washington D.C., 1994.
Major Depressive Disorder 296.3x
A. One of the following abnormal moods must be
significantly interfering with your life:
-
1. Abnormal depressed mood most of the day, nearly
every day, for at least 2 weeks.
-
2. Abnormal loss of all interest and pleasure most
of the day, nearly every day, for at least 2 weeks.
-
3. If 18 or younger, abnormal irritable mood most of
the day, nearly every day, for at least 2 weeks.
B. At least five of the following symptoms must have
been present during the same 2-week depressed period.
-
Abnormal depressed mood (or irritable mood if a
child or adolescent) [as defined in criterion A].
-
Abnormal loss of all interest and pleasure [as
defined in criterion A2].
-
Appetite or weight disturbance, either:
-
Sleep disturbance, either abnormal insomnia or
abnormal hypersomnia.
-
Activity disturbance, either abnormal agitation or
slowing (observable by others).
-
Abnormal fatigue or loss of energy.
-
Abnormal self-reproach or inappropriate guilt.
-
Abnormal poor concentration or indecisiveness.
-
Abnormal morbid thoughts of death (not just fear of
dying) or suicide.
C. The symptoms you experienced can not be due to a
mood-incongruent psychosis (e.g., Schizophrenia, Delusional or
Psychotic Disorders.)
D. There has never been a Manic Episode, a Mixed
Episode, or a Hypomanic Episode (i.e., Bipolar Disorder).
E. The symptoms experienced cannot be due to physical
illness, alcohol, medication, or street drug use.
F. The symptoms experienced cannot be due to normal
bereavement.
Diagnostic Assessment For Insurance Coverage
Patient Name
:
__________________________________________________________
Insurance Company/Plan
:
_______________________________________________
Patient I.D. Number
:
__________________________ DOB:
___________________
Assessment of Need for Phototherapy
This is to certify that I am currently treating the
above named patient for recurrent major
depressions (DSMIV-R-296.3) with a seasonal pattern.
This condition, known as Seasonal Affective Disorder
(SAD), has been shown in many
studies in the United States and Europe to respond to
treatment with bright environmental
light (phototherapy). Phototherapy is no longer
considered experimental, but is a mainstream
type of psychiatric treatment, 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 currently appears:
__ To be an isolated psychiatric disorder, or
__ Exists concomitantly with a previously-diagnosed
psychiatric disorder of other origins
(phototherapy being an addition to current other
treatments).
In order to administer phototherapy adequately, a
specialized lighting device, such as the
one described on 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. Because of necessary treatment
features as to time of day and duration of
use, the patient's possession of a home-use unit such
as I have prescribed is a requirement
for successful and practical therapy, and is, in my
opinion, the most cost effective
treatment alternative.
Code # and Diagnosis
DSM IV-296.3X - Major Depression, Recurrent (see
reverse for evaluation criteria)
These procedures conform to April 1993 U.S. Public
Health Service-Agency for Health
Care Policy and research guidelines for management of
this disorder.
Prescribing Doctor
____________________________ Date:
_____________
Signature
_____________________________
Practice lD No. ____________
Note: Please attach a prescription to this form.
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