The Insurance
Example
Instructions:
Many insurance companies will reimburse all or a portion of the cost of a light
therapy device if proper diagnosis has been made by a qualified health professional. The
following sample letter has been prepared to assist you in requesting reimbursement. It is
to be prepared and signed by your doctor.
SAMPLE LETTER FOR INSURANCE COMPANY
To whom it may concern: (Insurance carrier)
This is to certify that (your name) is a patient of mine. He/she is being
treated for recurrent major depressions with a seasonal pattern.
Referral to "seasonal patterns of depression" has been included in the most
recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Phototherapy
is no longer considered experimental, but is a mainstream type of psychiatric treatment
for Seasonal Affective Disorder (SAD). According to the December 8, 1993 issue of
The Journal of the American Medical Association (JAMA), "for many patients with SAD,
light therapy should be regarded as a first-line treatment, given its high success and
acceptance rate" (Vol. 270, No. 22, pages 2717-2720). In 1989, the American
Psychiatric Association's Task Force on Treatment of Psychiatric Disorders (Vol. 3, pages
1890-1896, A.P.A. Press), recommended light therapy as treatment for the range of clinical
depression diagnoses including:
| CODE NO. |
DIAGNOSIS |
| DSM IV-296.3X |
Major Depression, Recurrent |
| DSM IV-296.4X |
Bipolar Disorder, most recent episode-Manic |
| DSM IV-296.5X |
Bipolar Disorder, Depressed |
| DSM IV-296.6X |
Bipolar Disorder, Mixed |
| DSM IV-296.8 |
Bipolar Disorder, NOS |
| DSM IV-296.90 |
Mood Disorder, NOS - Seasonal Affective Disorder |
| DSM IV-311.00 |
Depressive Disorder, NOS |
In order to administer phototherapy adequately, a bright light unit is
required. In (your name)'s case, the use of the bright light unit should be
regarded as a medical necessity and may be used in conjunction with other forms of
treatment.
These procedures conform to April 1993 U.S. Public Health Service-Agency for Health
Care Policy and Research guidelines for management of this disorder.
| PUBLICATION # |
PUBLICATION TITLE |
| AHCPR93-0551 |
Depress: Guideline Vol. 2 |
| AHCPR93-0553 |
Depress: Patient Guide |
Sincerely,
Dr.________________________ |