A reader asks:
I have recently been diagnosed with SAD and am about to purchase a light box. Both Medicaid and Medicare have refused to contribute toward its cost. I am wondering if you have any suggestions on what my doctors and I can do to change their minds.
Answer:
Challenges with Reimbursement
We have heard of such reimbursements only rarely. The basic problem has been FDA’s long-standing disinclination to review the treatment method. Thus, insurers can dismiss it as “investigational,” rather than approved. The lack of FDA consideration is partly due to the failure of manufacturers to apply for pre-market approval, which entails significant cost (as is easily paid by the pharmaceutical industry, but not by small light box companies). It is also sometimes argued that such approval would restrict the technology to the prescription market, eliminating direct access by consumers.
Hope for Reimbursement in Future…
Meanwhile, there are several published consensus reports from professional organizations endorsing light therapy for SAD, and a strong statement is pending in the American Journal of Psychiatry. Increasingly, private insurers reimburse patients for the cost of light therapy apparatuses, given physician endorsement of reimbursement requests with appropriate DSM-IV diagnostic codes, e.g., 296.3 with seasonal pattern.
But not Now
We suspect that direct battle with Medicaid (or Medicare) will not succeed at this point, although protest by physicians might possibly catch the attention of government staff, and some constructive dialogue might ensue. Hope this information helps, even though we are pessimistic about your receiving coverage at this point.
