Understanding Your Phototherapy Insurance Benefits
Phothera home phototherapy is covered by most major insurance companies, including Medicare and Medicaid in many states. Our experienced team works closely with you and your insurance provider to minimize your out-of-pocket costs and ensure you receive the treatment you need.
We do not want cost to be a barrier to access.
Insurance Coverage Overview:
- Most major insurers cover phototherapy for psoriasis, eczema, vitiligo, CTCL and other photoresponsive skin conditions
- Medicare and Medicaid coverage available in many states
What Determines Your Out-of-Pocket Costs:
Your final out-of-pocket expense depends on several factors specific to your insurance plan:
- Your Deductible Status
- Whether you've met your annual deductible
- How much remains on your deductible
- Plan Type and Benefits
- HMO, PPO, or other plan structure
- Durable medical equipment (DME) coverage levels
- Copayment or coinsurance percentages
- Coverage Tier
- In-network vs. out-of-network benefits
- Specific coverage percentages for medical devices
- Medical Necessity Documentation
- Strength of supporting medical records
- Previous treatment history
- Severity of condition documentation
The Phothera Insurance Process:
Step 1: Prescription
Your healthcare provider prescribes Phothera home phototherapy and provides necessary medical documentation (detailed chart notes, insurance information and other documentation).
Step 2: Coverage Support
During the entire process Phothera's team is here to help, we will:
- Perform benefits check
- File claims on your behalf
- Handle prior authorization requests
- Appeal denials when appropriate
- Work with your provider for additional documentation
- Provide interest-free payments and financial assistance
- With Phothera Cares, eligible patients could pay as little as $0 out-of-pocket