August 24, 2020
Increasingly, people who undergo Calmare scrambler therapy (CPT Code 0278T) are not accepting their medical insurance denial of coverage.
Patients are appealing the decision.
And they are winning!
Here is a recent example where a UnitedHealthcare member with CRPS appealed their denial of coverage for scrambler therapy in California:
An independent medical review organization (“IMRO“), in a rereview case filed with the California Department of Insurance, recommended overturning an insurance treatment coverage denial by the UnitedHealthcare Insurance Company for Calmare Therapy used to treat pain and physical symptoms from Complex Regional Pain Syndrome (“CRPS“).
In the determination letter sent to a patient last month, the IMRO’s final determination was as follows:
FINAL DETERMINATION: OVERTURN. This means we disagree with UnitedHealthcare Insurance Company’s decision to deny reimbursement for transcutaneous electrical modulation pain processing provided from 12/03/18 through 5/14/19.
Two out of three medical experts decided transcutaneous electrical modulation pain processing (scrambler therapy) provided was likely to have been more beneficial for the enrollee than any available standard therapy.”
Per CIC Section 10169.3(f), the California Department of Insurance adopts the decision of the IMRO. The IMRO decision is final and not subject to further appeals.
Read the full announcement here:
While Calmare is generally an out-of-network therapy, we will work closely with you to provide any and all documentation you may require to help win reimbursement from your medical insurance company.
We especially encourage CRPS warriors to keep the link to the article above to use as ammunition as well.
To discuss your chronic pain condition, call us at (201) 933-4440 or email us privately at info@calmaretherapy nj.com.
Clinical Director Dr. Michael Cooney is one of only seven Calmare Certified providers in the US. He specializes in treating CRPS and PHN, a nerve pain condition resulting from Shingles. Learn more about the wide array of neuropathic conditions that may be mitigated by the use of non-invasive, side-effect-free scrambler therapy https://calmaretherapynj.com/chronic-pain-conditions/