When it comes to convincing government and private medical insurance to cover newer medical treatments, it can feel like climbing a mountain. At night. With no shoes. In the pouring rain.
But, we’re happy to begin to see some light at the end of the tunnel. At last, health insurers are recognizing the cost benefit and effectiveness of Calmare’s scrambler therapy in comparison to endless medications, expensive and invasive chronic pain treatments such as Ketamine therapy and spinal chord stimulators (SCS).
Here is what we know or have been advised to date:
The following states are covering scrambler therapy:
*There have been sporadic reimbursements for indications including CIPN, RSD, Herpes and CRPS from the following private health insurers who have approved and paid for at least one patient of treatment for Scrambler Therapy:
The Empire Plan
*Patients have reported the highest percentage of success when they appeal an initial denial of coverage.
Additionally, patients living in New York and Wyoming with private insurance have reported the highest percentage of coverage in the U.S., to date.
Without appeals or submittal of claims for coverage, the insurance company’s Medical Directors see no demand from providers for the new technology and therefore have little motivation to establish coverage.
CPT Code for Scrambler Therapy
The AMA released the new CPT code (0278T) on January 1, 2012. This code is now used by all Scrambler therapy sites for billing/reimbursement claims.
If you live in a state where Worker’s Comp offers coverage and would like to pursue Calmare Therapy:
1) Schedule a consultation with a certified Calmare provider to determine if your medical condition is appropriate for Calmare Therapy. Bring along your medical records and a history of other chronic pain treatments you have undergone.
2) IF your doctor confirms Calmare is appropriate for your medical condition, contact your Worker’s Comp representative to obtain “pre-certification” before beginning treatment.
There is activity, we are getting there
Slowly but surely, insurers are beginning to see that scrambler therapy is a cost-effective treatment to help people minimize or eliminate chronic pain which is preventing them from working and enjoying the high quality of life they deserve. It’s proven and remarkably inexpensive in comparison to prescription drugs, Ketamine therapy, spinal cord stimulators (SCS) and other invasive and painful treatments.
But patients and their loved ones must put up a fight. What does this mean? According to patients we have spoken with who received reimbursement for Calmare, they did not accept the bevy of “Denial of Coverage” form letters. They wrote their own letters, appealed, appealed and appealed until someone listened.
As a Calmare provider, we will do anything we can to help you win the coverage you deserve. We have staff that interacts with insurance companies and Worker’s Comp personnel 40 hours a week. We are fighting the same battle, right beside you.