February 20, 2019
I have a prescription for a cooling vest from my ms doctor. Where can I get one and how do I know if my insurance will pay for it.
Congrats on getting the prescription for a cooling vest! That is awesome.
You can purchase a UnderCool Cooling Vest through us once a few steps are completed.
Please note ThermApparel is not responsible for your prescription, claim or denial and we can not guarantee that theses steps will work as each insurance company, situation and patient are different.
1. Contact your insurance company and tell them you have a prescription for a cooling vest and ask them what their steps are.
2. If they cover it, awesome! Ask how reimbursement works. ThermApparel is unable to submit the paperwork for you so you will have to get approval from the insurance company, purchase the vest and then submit your receipt for reimbursement. Insurance companies will not reimburse you for the vest if you purchase before their approval date.
3. They will most likely say that the cooling vest is not covered as a durable medical device and therefore they wont cover it.
4. That's ok... there are a few things you can do, but they take a bit of work.
5. Ask them what their financial threshold is and what it is for your plan. It's usually in the $300-$500 range and that's great because UnderCool starts at $199. The range will depend on the insurance company and your individual plan. If the price falls into that range ask how you can purchase a cooling vest with that and ask about the reimbursement steps..
6. If step 5 doesn't work we can supply you with a Letter of Predetermination and a Letter of Network Deficiency. Send us an email at firstname.lastname@example.org and fill us in where you are in the process and we can get the letters out to you..
7. Get a Letter of Medical Necessity from your doctor.
8. Submit all three letters and your prescription to the insurance company and wait but be persistent and nice and follow up onsistently. Be prepared that they will most likely decline your claim.
9. If they accept it awesome!! refer to step 2 and ask about how reimbursement works before you purchase any cooling vest.
10. If they deny your claim there are still things you can do.
11. File an appeal. We have some helpful tips below.
12. Apply to a few organizations and foundations for financial assistance with purchasing a cooling vest.
Tips for Filing an Appeal Letter for A Cooling Vest
The National MS Society publishes a Health Insurance Appeal Letter Toolkit for Clinicians, It's ok if you are not a clinician, you can still use the template for the Cooling Vest Appeal Letter. You have to scroll down quite a bit to get to the Cooling Vest Model Appeal Letter and Abstracts of Studies Cited in Letters
The 2 studies that are mentioned in the model appeal letter:
Clinical and Immunological Effects of Cooling in Multiple Sclerosis
P.K. Coyle, L.B. Krupp, C. Doscher
A randomized controlled study of the acute and chronic effects of cooling therapy for MS.
SR Schwid, MD Petrie, R Murry
1. Create your own Cooling Vest Appeal Letter based on the template from the Health Insurance Appeal Letter Toolkit for Clinicians,.
2. Submit the Cooling Vest Appeal Letter and the 2 studies via email, snail mail, carrier pigeon etc or our recommendation, the approved method from your insurance company.
3. Wait to hear back from the insurance company but be persistent and nice and follow up consistently .
Tips for Applying to A Cooling Program for Financial Assistance with a Cooling Vest
Please note: You can only get an UnderCool Cooling Vest from the MS Foundation. UnderCool is not available through MSAA, but they do have other cooling options that might work for you.
There many foundations and organizations out there that offer financial assistance for various things MS related. Here are our suggestions for Financial Assistance with Cooling Vests.
National MS Society - 1-800-344-4867
MS Navigator brochure
The Navigators are awesome and can help you with financial assistance for a vest and with the appeal process.
Other National MS Society helpful links.
Insurance and Financial Info
Financial Assistance Programs (Medication)
We hope this helps. Please let us know your thought and tips in the comment section.
play cool. stay cool. be cool.
ThermApparel is a small business making big waves in the MS world by designing the first lightweight, comfortable and invisible cooling vest, UnderCool. Check us out online, on our blog, or on Facebook, Twitter, Pinterest, LinkedIn and Instagram.
Please let us know if you have any other questions or ideas in the comments below, we will follow up..
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