Insurance Coverage

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 according to your insurance provider and you can start the authorization process.

Please 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 the UnderCool. If you would like to learn more about these options please scroll down to the bottom of the page. 

Before you begin...

If you decide to file for an insurance claim, we recommend these steps so you are not stuck calling the same people over and over, because being on hold is no fun :(

  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 on hand.  Insurance providers may want you to mail or fax these records with the claim.

  3. Check with your health care provider. Let them know you are waiting to purchase a Cooling Vest.  ThermApparel is a registered DME vendor. The healthcare code to classify the UnderCool is E1399. Because of this code some healthcare providers may only need a letter of medical necessity written by your doctor and an invoice from us.

  4. Collect the necessary forms. You can download a template for the letter of medical necessity here to give to your doctor to alter for your needs. Also, make sure you send us an email at contact.us@thermapparel.net so we can provide you with an invoice to supply to the insurance company.

  5. (If necessary) Fill out our medical release form. Some insurance providers may call ThermApparel to inquire about your claim. Please fill out this form and email it to our insurance coordinator at contact.us@thermapparel.net so we can discuss the claim on your behalf to your insurance provider.

 

Your privacy and confidentiality are of utmost importance to us. Any personal or medical details we discuss during your case are shredded once your case has been settled. You can call us with any questions at 855-232-7233.

 

For MVP Members

MVP requires you to submit a Prior Authorization Form to determine whether the cooling vest is a medical necessity that can be covered under your plan. With your medical provider, fill out the left-hand side of this form. Submit your medical history and records along with the completed form to MVP. Do not purchase your UnderCool until you have received approval from MVP. Once you have received approval, make your purchase in our shop. Fill out MVP's claim form, attach your receipt, and submit the form. MVP will then process your claim and reimburse you. 

 

For Excellus Blue Cross Blue Shield Members

Excellus requires a statement of medical necessity from your prescribing doctor which indicates how long the cooling vest will be used as well as a statement from ThermApparel showing rental versus purchase price. ThermApparel does not offer rentals of our cooling vests so the statement is not applicable. Do not purchase your UnderCool until you have received approval from Excellus. Once you have received approval, make your purchase in our shop. Fill out Excellus's claim form, attach your receipt, and submit the form. Excellus will then process your claim and reimburse you. 

 

For Humana Members

Humana must determine the medical necessity of a cooling vest under your plan. You must call the clinical intake line 1-800-523-0023 and provide your member and medical information for review. Do not purchase your UnderCool until you have received approval from Humana. Once you have received approval, make your purchase on our shop. Fill out Humana's claim form, attach your receipt, and submit the form. Humana will then process your claim and reimburse you. 

 

Don't see your insurance provider?

Don't panic! Many insurance providers may cover a cooling vest. Call your insurance provider and ask what the steps are for getting a cooling vest.

Was your claim Denied?

If your health insurance provider denies your claim, you can file an appeal with your prescribing doctor. The MS Society has compiled template insurance appeals which you can view here. Page 14 shows an appeals template for cooling vests. We have also written a template letter defending the use of cooling garments for people living with heat sensitivity due to MS. You can view that letter here.

For more information on filing an appeal, visit the MS Society's Appeals Resources page here.

 

HSA/FSA Accounts

ThermApparel is pleased to announce that our website is accepting HSA/FSA Debit Cards!  Please contact your Insurance Company before you purchase a vest to make sure that they will accept this use of the funds. Then make your purchase in our shop.