Did you know that cooling vests may qualify for insurance coverage as DME (Durable Medical Equipment)? Most insurance providers require proof from your doctor that you need a cooling vest for medical reasons. Meeting the requirements from an insurance provider can be tricky but at ThermApparel we try to make it easy. Follow the steps below and you can start the authorization process.

Please note: ThermApparel is a small company and we cannot bill any insurance provider directly. But we can help the process by providing invoices / and information on our product.

Did you receive a prescription for a cooling vest? That is awesome. You can purchase a UnderCool Cooling Vest through us once the approval process is completed.

Be patient with the approval process as most insurance providers require weeks to come to a decision. In most cases, insurance providers will reject your first claim. In this case, you will need to submit an appeal to reverse the rejection. Appeals require another few weeks for insurance providers to review.

We have had customers use their HSA (Health Savings Account) or FSA (Flexible Spending Account) to purchase UnderCool. Please contact your insurance provider before you purchase to make sure they will accept this use of your funds. Then make your purchase in our shop.

Please note, ThermApparel is not responsible for your prescription, claim or denial and we can not guarantee that these steps will work as each insurance company, situation and patient are different. Here are a few tips to ensure the process goes as smooth as it can: 

  1. Talk to your doctor. It's important to talk to your doctor or healthcare provider to receive their support as many insurance providers require a written prescription and letter of medical necessity from your doctor.

  2. Gather all of your relevant medical records and history. Insurance providers may want you to mail or fax these records with the claim.

  3. Contact your insurance company. Let them know you are wanting to purchase a cooling vest. ThermApparel is a registered DME vendor. The healthcare code to classify UnderCool is E1399. Because of this code, some insurance providers may only need a letter of medical necessity written by your doctor and an invoice from us.

  4. 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 first, then purchase an UnderCool according to their accept and reimbursement rules. Insurance companies will not reimburse you for UnderCool if you purchase before their approval.

  5. If they deny it and say UnderCool is not covered as a durable medical device, they wont cover it. That's ok! There are a few other things you can do, but they take a bit of work on your part.

  6. Ask your insurance provider what is the financial threshold for needing prior authorization for your plan. Let your insurance provider know that UnderCool costs less than $500 as this is a general threshold for needing prior authorization. Because of this, some providers will automatically approve your UnderCool purchase. Please remember to wait for approval before purchasing UnderCool and ask your insurance provider what their reimbursement steps are.

  7. If step 6 doesn’t work, we can supply you with a Letter of Network Deficiency and an invoice. Send us an e-mail at contact.us@thermapparel.net and fill us in where you are in the process and we can get the letters out to you. We will need your full name (as it appears on your insurance card), mailing address and date of birth.

  8. Get a Letter of Medical Necessity from your doctor. You can download a template here for your doctor to alter for your specific needs.

  9. Submit all three letters, prescription and invoice to your insurance provider and wait. Be persistent and nice and follow up consistently. Be prepared that they will most likely decline your claim.

  10. If they accept it, awesome! Clarify with your insurance provider how reimbursement works before you purchase UnderCool and then purchase in our shop or call us 855-232-7233.

  11. If they deny your claim, there are still things you can do. Try to file an appeal or apply to a cooling program.

 

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 are: 

  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 e-mail, snail mail, carrier pigeon etc. to your insurance provider.

  3. Wait to hear back from the insurance company, but be persistent and nice and follow up consistently.

Questions about our vests or shipping? Reach out to the ThermApparel team toll-free at 855-232-7233, write to us through our website’s contact form or chat with us via live chat. We always respond because, otherwise, that wouldn't be cool.