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Health Insurance Coverage

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:

  1. Lifestyle Disruption: the daily activities of the patient must be disrupted significantly.
  2. Pain: The patient must be experiencing pain as a result of their condition.
  3. Failure of Conservative Measures: Other methods of treatment have failed to provide adequate relief.
  4. 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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