I have a prescription for a cooling vest from my doctor how do I know if my insurance will pay for it?
Did you know that cooling vests may qualify for insurance coverage as DME (Durable Medical Equipment)? Most insurance providers require proof from your doctor that you need a cooling vest for medical reasons. Meeting the requirements from an insurance provider can be tricky but at ThermApparel we try to make it easy. Follow the steps below and you can start the authorization process.
Please note: ThermApparel is a small company and we cannot bill any insurance provider directly. But we can help the process by providing invoices and information on our product.
Congrats on getting the prescription for a cooling vest! That is awesome.
You can purchase a UnderCool Cooling Vest through us once the approval process is completed. Be patient with the approval process as most insurance providers require weeks to come to a decision. In most cases, insurance providers will reject your first claim. In this case you will need to submit an appeal to reverse the rejection. Appeals require another another few weeks for insurance providers to review.
We have had customers use their HSA (Health Savings Account) or FSA (Flexible Spending Account) to purchase UnderCool. Please contact your insurance provider before you purchase to make sure they will accept this use of your funds. Then make your purchase in our shop.
1. Talk to your doctor. It's important to talk to your doctor or healthcare provider to receive their support as many insurance providers require a written prescription and letter of medical necessity from your doctor.
2. Gather all of your relevant medical records and history. Insurance providers may want you to mail or fax these records with the claim.
3. Contact your insurance company. Let them know you are wanting to purchase a Cooling Vest. ThermApparel is a registered DME vendor. The healthcare code to classify UnderCool is E1399. Because of this code some insurance providers may only need a letter of medical necessity written by your doctor and an invoice from us.
4. If they cover it, awesome! Ask how reimbursement works. ThermApparel is unable to submit the paperwork for you so you will have to get approval from the insurance company first then purchase UnderCool according to their accept and reimbursement rules. Insurance companies will not reimburse you for UnderCool if you purchase before their approval. They will most likely say UnderCool t is not covered as a durable medical device and therefore they wont cover it. That's ok... there are a few things you can do, but they take a bit of work on you part.
5. Ask your insurance provider what is the financial threshold for needing prior authorization for your plan. Let your insurance provider know that UnderCool costs less than $500 as this is a general threshold for needing prior authorization because of this some providers will automatically approve your UnderCool purchase. Please remember to wait for approval before purchasing UnderCool and ask your insurance provider what their reimbursement steps are.
6. If step 5 doesn’t work we can supply you with a Letter of Predetermination, Letter of Network Deficiency and an invoice. Send us an email at firstname.lastname@example.org and fill us in where you are in the process and we can get the letters out to you..
7. Get a Letter of Medical Necessity from your doctor. You can download a template here for your doctor to alter for your specific needs.
8. Submit all three letters, prescription and invoice to your insurance provider and wait. Be persistent and nice and follow up consistently. Be prepared that they will most likely decline your claim.
9. If they accept it awesome!! Clarify with your insurance provider how reimbursement works before you purchase UnderCool and then purchase in our shop or call us 855-232-7233
10. If they deny your claim there are still things you can do. File an appeal or apply to a cooling program.
Tips for Filing an Appeal Letter for A Cooling Vest
The National MS Society publishes a Health Insurance Appeal Letter Toolkit for Clinicians, It’s ok if you are not a clinician, you can still use the template for the Cooling Vest Appeal Letter. You have to scroll down quite a bit to get to the Cooling Vest Model Appeal Letter and Abstracts of Studies Cited in Letters
The 2 studies that are mentioned in the model appeal letter:
Clinical and Immunological Effects of Cooling in Multiple Sclerosis
P.K. Coyle, L.B. Krupp, C. Doscher
A randomized controlled study of the acute and chronic effects of cooling therapy for MS.
SR Schwid, MD Petrie, R Murry
1. Create your own Cooling Vest Appeal Letter based on the template from the Health Insurance Appeal Letter Toolkit for Clinicians,.
2. Submit the Cooling Vest Appeal Letter and the 2 studies via email, snail mail, carrier pigeon etc or our recommendation, the approved method from your insurance company.
3. Wait to hear back from the insurance company but be persistent and nice and follow up consistently .
Tips for Applying to A Cooling Program for Financial Assistance with a Cooling Vest
Please note: You can only get an UnderCool Cooling Vest from the MS Foundation. UnderCool is not available through MSAA, but they do have other cooling options that might work for you.
There many foundations and organizations out there that offer financial assistance for various things MS related. Here are our suggestions for Financial Assistance with Cooling Vests.
National MS Society - 1-800-344-4867
MS Navigator brochure
The Navigators are awesome and can help you with financial assistance for a vest and with the appeal process.
Other National MS Society helpful links.
Insurance and Financial Info
Financial Assistance Programs (Medication)
We hope this helps. Please let us know your thought and tips in the comment section.
play cool. stay cool. be cool. 😀
ThermApparel is a small business making big waves in the MS world by designing the first lightweight, comfortable and invisible cooling vest, UnderCool. Check us out online, on our blog, or on Facebook, Twitter, Pinterest, LinkedIn and Instagram.
Please let us know if you have any other questions or ideas in the comments below, we will follow up..
You can always reach us via:
live chat - www.thermapparel.net
email - email@example.com
phone - 855-232-7233