📋 Electrolysis/Laser Hair Removal Coverage Guide

Introduction

This guide is intended to help individuals who have a Denver Health "Elevate" Medical Plan (DHMP) navigate the process for ensuring their electrolysis and/or laser hair removal sessions are covered correctly. This is the culmination of months of work, conversations with DHMP, medical providers, and electrolysis/laser hair removal professionals. It can be a confusing process, so I hope you find this useful in your own journey.

This guide is based on my personal experience with DHMP. It is not applicable to other insurance providers. If you have a different insurance provider, reach out to them directly to inquire about coverage for electrolysis and laser hair removal, as well as the process for obtaining pre-authorization and reimbursement.

Overview of the Process

The process for getting electrolysis and/or laser hair removal covered by DHMP can be broken down into three main steps:

1. Verify your coverage
2. Get a pre-authorization
3. Requesting reimbursement

The following resources were provided by DHMP and will be referenced throughout this guide:

• DHMP Resources Page
• DHMP Pre-Authorization Form
• DHMP Reimbursement Form

Step 1: Check your coverage

Before we get too deep, let's double-check your plan details to ensure Electrolysis is included in your health plan coverage. This is outlined in your member handbook. These handbooks are specific to each individual health plan offered by DHMP. It's important to reference the relevant one. Refer to the top of your insurance card for your specific plan name, then locate your member handbook here.

Within your handbook find the section titled "Benefits/Coverage (What’s covered?)". Below that is a sub-section titled "Gender Dysphoria and Gender-Affirming Care" with a list of services. If you see "Electrolysis" or "Laser hair removal" listed (depending on what you're looking to get covered), then you're good to go! If not, you may want to reach out to DHMP to clarify whether it's covered under a different name or if there are any specific requirements for coverage.

Step 2: Get a pre-authorization

DHMP requires pre-authorization in order for electrolysis and laser hair removal to be covered. There are two routes to obtaining this:

Route 1: Through your hair removal provider

Contact your electrolysis or laser hair removal provider and ask them to submit a pre-authorization request on your behalf. This is preferred, but not all providers are capable of doing this.

If your provider is able to submit the request, they will likely also be able to bill your insurance directly, which is ideal. If they are not able to bill your insurance directly, you can still go this route to get the pre-authorization, but you will need to pay out of pocket for your sessions and then submit a claim to DHMP for reimbursement (see below).

Route 2: Through your primary care provider

Contact your primary care provider and request they submit the pre-authorization form. You can download the pre-auth form here. You will need to provide the following information to your provider to fill out the form:

• Contact Name (typically the person treating you)
• Facility Name
• How much time is needed for the procedure. This is typically stated in 30-minute increments. So for example include "1 hour per week" or "3 hours per week". This is dependent on your treatment plan and goals. It is recommended to talk with your hair removal provider to determine the appropriate amount of time to request.

The form requires additional information such as the CPT code for the procedure, diagnostic code, NPI number, and more. Your primary care provider should be able to gather this information and able to fill it out without your input. Be sure to ask for a copy of the completed form for your records.

Once the form is submitted, it typically takes about 1-2 weeks for DHMP to process the request. You can follow up with DHMP after this time frame to check on the status of your pre-authorization.

Step 3: Getting reimbursed

At your appointments, you'll pay out of pocket and they will give you a receipt. All receipts will look different, and you need this in addition to the reimbursement form provided by DHMP which you can download here.

Patient information:
Fill out the form with your information. It's recommended that you fill this out on your computer instead of writing by hand to ensure the information is legible.

Provider information:
Fill out the provider information section with the details of your hair removal provider. This information should be available on your pre-authorization form. If you are missing any information, reach out to your hair removal provider.

The form requires a "Provider Tax ID Number", you can use the NPI instead. Just put "NPI: followed by the providers NPI number in that box instead of a Tax ID.

If your provider does not have an NPI number, you can reach out to DHMP to clarify what you should put in this field. It should not be necessary. DHMP stated to me in writing:

"Unfortunately, the form may have more details than actually needed because it is used for Medical services that may need reimbursement and not specific to each service that may need reimbursement."

Services:

You can include up to 4 individual sessions on one form, so you can submit less forms if you had multiple sessions. There is a time limit for submitting reimbursement requests, so be sure to submit your forms promptly. According to DHMP requests must be submitted within 180 days of the date of service. However, sending them as soon as possible is recommended, especially if you had multiple sessions, to ensure you don't miss the deadline for any of them. Insurance companies also like reimbursing smaller increments instead of large sums, something to keep in mind when deciding how many sessions to include on each form.

In the "Services" section, list each session you had with all the required information:

• Date of service: (The From and To dates will be the same)
• Place of service: (DHMP informed me this should be "11")
• Furnished via audio/video?: (No, unless your provider is magical)
• CPT/HCPCS Code: (Typically 17380 for electrolysis, refer to your completed pre-authorization form)
• Diagnosis code: (Typically F64.0 or F64.9, refer to your completed pre-authorization form)
• Charge per Unit/Day: (Calculate how much each 30 minutes of service costs, for example if total charge is $100 for one hour this would be $50)
• Number of Units/Days: (Divide your total time by 30 minutes, i.e. 60 minutes / 30 minutes = 2 units)
• Total Charge: (The total charge for the session including any applicable taxes)

Once the form is filled out, signed, and dated, you can submit it to DHMP along with your receipts. You must submit these via mail, further instructions are included on the first page of the reimbursement form. It typically takes a few weeks for DHMP to process the reimbursement, and they will send you a check in the mail for the reimbursed amount. You should be able to track the status of your claim in the DHMP portal or by contacting DHMP directly.

If you have any issues with reimbursement, you can reach out to DHMP for clarification and assistance. Be sure to keep copies of all your forms and receipts for your records in case you need to reference them in the future.

Helpful tips

• Create a spreadsheet to keep track of appointments, the information needed for the reimbursement form, and the status of each reimbursement request. This helped me stay organized and ensure I didn't miss any deadlines for submitting my reimbursement requests.
• Keep a copy of everything you submit to DHMP and any correspondence you have with them. This will be helpful in case you need to reference it later or if there are any issues with your reimbursement requests. I kept a folder on my computer with all my forms, receipts, and correspondence with DHMP organized by date, which made it easy to find what I needed when I needed it.
• Fill out the form as completely as possible ahead of time on the computer. Then just add in the date, charges, and units for each session before submitting. This saved me a lot of time and effort when it came to filling out the forms. It also allowed me to print out several forms at once and update the remainder of information by hand as needed (example below).

Final thoughts

Navigating insurance coverage for electrolysis and laser hair removal can be a complex and sometimes frustrating process, but with the right information and resources, it is possible to get the coverage you need. I hope this guide has been helpful in outlining the steps and providing some tips for navigating the process with DHMP. Remember to always advocate for yourself and don't hesitate to reach out to your insurance provider or healthcare provider if you have any questions or need assistance along the way.

Disclaimer

This guide is not legal or medical advice, and may not be construed as such. Rather, consider this a resource to help navigate the process for these specific services. Always consult with your healthcare provider and insurance company for personalized guidance and information about your medical needs and coverage.