HMO & PPO:
Both HMO's and PPO's have two categories
under which treatments may fall:
- Cosmetic Procedures
- Medically Necessary Procedure
The
majority of laser resurfacing procedures will fall under the
category of cosmetic procedure, and as such, will not be covered
by insurance providers. Surgical procedures are more likely
than injection treatments or Laser/Light therapy to be covered
as a "medically necessary procedure".
Insurance companies use varying criteria in order to determine
if a treatment is to be considered "medically necessary."
These criteria may include one or more of the following:
Lifestyle Disruption: the daily activities
of the patient must be disrupted significantly.
Pain: The patient must be experiencing
pain as a result of their condition.
Failure of Conservative Measures: Other
methods of treatment have failed to provide adequate relief.
Complications: Complications, such
as infection, make it more likely an insurance company will
consider treatment medically necessary.
MEDICARE
Medicare will generally not reimburse for these procedures. You will
have to contact your facility to determine whether they are participating
in Medicare and whether your treatment may be covered. Any secondary and
supplemental insurance company will require Medicare to decline the service
before they will consider reimbursement. Most clinics will offer you a
variety of payment methods. Please ask your specialist about payment options
during your consultation. For further insurance information, contact you
insurance provider for coverage options.
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