I am getting tired and frustrated with my health insurance provider. Really.
On December 15, 2017 my dermatologist, Dr. Maverakis, prescribed a home narrowband Uphototherapy unit. This unit, costing about five-thousand dollars, would treat both my psoriasis and atopic dermatitis (eczema).
With changing medical providers on January 1, I waited until I could see my new dermatologist. After almost missing the appointment, she agreed to submit the application that Dr. Maverakis started a couple months prior.
Surprise! not too long after I received the response from Western Health Advantage, my church’s health insurance provider.
First Insurance Denial
Here’s an excerpt from the letter:
“The requested service, Home UV Photo therapy booth is being denied by Western Health Advantage (WHA) because it is currently considered Experimental/Investigational for a diagnosis of Psoriasis/Atopic Neurodermatitis. . . . and not a covered benefit under your health insurance plan.”
I couldn’t believe that WHA called home phototherapy “Experimental/Investigational” when I had used it effectively for many years earlier in life. I felt pessimistic about winning an appeal given how their reasoning, and how onerous the appeal process feels.
Nonetheless, Dr. Carroll and I both sent appeals to WHA. Below is a copy of my letter, which I certainly thought would change the minds of those making those hard decisions at the insurance company:
I am writing with regard to a denial letter I received dated February 23, 2018 for a Home UV Photo Therapy unit. I would like to appeal the denial of my dermatologist’s request for this unit to treat my psoriasis and atopic dermatitis.
With the careful supervision of my dermatologists, I have successfully and effectively used phototherapy at home for my skin conditions for many years. Starting in 1981 my father and I built a box with a design and prescription from UCSF Dermatology. I used that UVB unit design off and on for over 25 years until I moved back to California in 2006. Thereafter I began using cyclosporine, which helped greatly. Now I need to stop using cyclosporine.
I have also utilized phototherapy at the clinic at various times over the past forty years, but do not feel at this time I can go to Sacramento from the Davis/Woodland area three times a week due to my work schedule demands and family needs. I thought a home unit would be perfect to augment my current psoriasis treatment.
Also, I feel it would help my atopic dermatitis. Since tapering down on cyclosporine treatment due to high blood pressure concerns, my atopic dermatitis has become more unpredictable and severe. I mainly use topical steroids for atopic dermatitis, which is not a good long-term solution given the widespread area it affects my skin. My dermatologist and I also considered using Dupixent, the new biologic for atopic dermatitis, but wanted to try the home phototherapy unit first.
While I understand the medical literature is conflicting as to the safety and efficacy of home phototherapy, each patient is an individual and unique case. In my case I need a combination of therapies to keep my immune mediated skin conditions under control.
I do hope that WHA reconsiders approving the phototherapy unit for me given my medical history of using a myriad of treatments over40 years, including home phototherapy.
Howard H Chang
Second Insurance Denial
The appeals did not work. On March 21st my wife and I heard a package delivered to the front door. Insurance sure does spend a lot of money using FedEx to send denial letters overnight!
The argument now, in addition, is that a phototherapy unit is a convenience item, not unlike a television or radio. What? That’s really what they wrote.
Excerpt from the letter:
“The following services and supplies are excluded or limited: ‘Personal comfort or convenience items and home or automobile modifications or improvements. This includes, but is not limited to, televisions, radios, chair lifts and purifiers.’ . . . Specifically, a Home UV Photo Therapy Booth is considered a convenience item and is not a coverered benefit.”
I understand that WHA does not want to pay for this unit. But calling it not medically necessary, and a convenience item flies in the face of current dermatologic medical practice. Or am I going crazy? I am going crazy.
I Give Up?
At this time I need to lick my wounds and discuss with my dermatolgist what to do next. At the National Psoriasis Foundation corporate roundtable in Chicago last summer someone mentioned to me that my dermatologist can request to talk to another dermatologist at the insurance. That might be the way to go as the physician who wrote the second letter is not a specialist.
I am also considering buying a scaled down unit directly from the manufacturer. Another option is to just get out in that beautiful California sunshine that should be arriving any day with the coming of spring. WHA can’t stop me from going to my backyard to get some naturaly UVB.
Whatever happens next I won’t give up, though I honestly don’t know how effective more appeals will be. The more I appeal, the more reasons they give to NOT cover the phototherapy booth. Still, at the end of the day, I am grateful for WHA covering my biologics and my family’s hospital stays. But the UVB unit would be nice too.