Does Insurance Cover Laser Hair Removal? Part 2
Welcome to the second installment of our series examining insurance coverage for laser hair removal. If you haven’t already, check Part 1 of this blog.
Let’s continue to dot the I’s and cross the T’s with insurance coverage and reimbursement for laser hair removal.
There are many hoops to jump through to get laser hair removal reimbursement.
Unfortunately, that’s true.
When a client’s insurance plan provides therapy – in this case, laser hair removal (LHR) – for a diagnosis when a client’s medical history supports medical necessity after other forms of therapy have failed, a gap exception may be used. A gap exception is when insurance provides benefits, but the client cannot find an in-network provider. Out-of-network benefits may be considered at in-network rates with a lower deductible and better coinsurance.
This is when you cannot find an in-network provider. A gap exception may allow for an out-of-network (OON) provider to be considered in-network. This is a significant benefit for the client. They’ll pay less out-of-pocket with benefits at the in-network rate or a lower deductible.
A client could have a medically necessary diagnosis and an out-of-network benefit with their insurance, meaning it’s not an HMO, it’s not Medicaid, and it’s not Medicare. They have the benefits available, but that doesn’t always mean laser hair removal is covered.
It’s a complicated process, and it depends on each insurance company and then further digresses into the type of plan the employer or client has for benefits.
Sometimes the reason for insurance denial of a claim is due to the CPT code 17999 being an unlisted code. Since 17999 is an unlisted code, insurance almost always requests medical records – an insurance delay of benefits – and to verify if the referring provider’s medical record reflects prior therapy to support a new therapy of laser hair removal.
A ton of work goes into it, with many hoops to jump through
Discuss the process of getting laser hair removal covered or reimbursed by insurance.
A ton of work goes into it, with many hoops to jump through.
Most clients aren’t seeking that prior authorization before accessing laser hair removal, and that’s a justification for insurance companies to deny it.
However, it’s less likely to be denied if:
- You have a diagnosis, your medical chart supports that diagnosis, and laser hair removal is being considered a new therapy if prescriptions, electrolysis, shaving, waxing, or other methods have failed
- You can find documentation to support laser hair removal as a therapy
- You can provide proof that unwanted hair has caused stress and physical or emotional impairment which is also disrupting daily activities
How can I give myself the best chance at having laser hair removal covered by insurance?
In addition to the medical record, providing a referral letter of medical necessity (LMN) is required. Referrals are typically submitted by the provider who diagnosed and treated the client.
Depending on the diagnosis, the provider may be a primary care physician, surgeon, dermatologist, ObGyn, counselor/therapist, endocrinologist, etc.
The referral should include:
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- Proof within the client’s medical record that shows unwanted hair causes undue physical or emotional distress
Medical history
- Any complications associated with the diagnosis and/or not receiving laser hair removal
When the diagnosis was established
- The therapy received (which may include prescriptions/over-the-counter medications or remedies, prior or planned procedures like at-home intense pulsed light/shaving/plucking, hormone therapy, sexual orientation counseling directed toward gender identity disorders, etc. – with the associated ICD-10-CM codes)
- How the client can benefit from laser hair removal
- Provider’s credentials depending on state/insurance requirements