Alternative Healers or Treatments

Non-traditional healing treatments provided by professionals may be eligible if provided to treat a specific medical condition. The treatments must be legal and the expenses do not qualify if the remedy is a food or substitute for food that the person would normally consume in order to meet nutritional requirements. Drugs and medicines recommended by alternative healers to treat a specific medical condition also can qualify as medical care, however as of December 31, 2010 a health care professional must provide evidence of medical necessity for these treatments to be an eligible medical expense. Include evidence of medical necessity by providing a Letter of Medical Necessity (LMN) that specifically identifies the recommendation and expense is for treatment of a medical condition with the request for reimbursement.

Alopecia Treatment (Baldness)

Alopecia is a Medical Condition resulting in the loss of hair from the body or head that can lead to baldness. A health care professional must provide evidence of medical necessity for the cost of a Alopecia treatment to be an eligible medical expense. Include evidence of medical necessity by providing a Letter of Medical Necessity (LMN) that specifically identifies the recommendation and expense is for treatment of a medical condition with the request for reimbursement. This condition can also be attributable to normal male pattern baldness. Treatment for this is not eligible if the sole purpose is to enhance appearance.

Allergy Treatment Products

A health care professional must provide evidence of medical necessity for the cost of a alergy treatment products to be an eligible medical expense. Include evidence of medical necessity by providing a Letter of Medical Necessity (LMN) that specifically identifies the recommendation and expense is for treatment of a medical condition with the request for reimbursement. If the product could be owned even without allergies (such as a pillow or vacuum cleaner), the expense is generally not an eligible expense.

Air Conditioners/Air Purifiers

A health care professional must provide evidence of medical necessity for the cost of a portable or permanent unit to be an eligible medical expense. Include evidence of medical necessity by providing a Letter of Medical Necessity (LMN) that specifically identifies the recommendation and expense is for treatment of a medical condition with the request for reimbursement.

Abdominoplasty

A health care professional must provide evidence of medical necessity for the procedure to be an eligible medical expense. Include evidence of medical necessity by providing a Letter of Medical Necessity (LMN) that specifically identifies the recommendation and expense is for treatment of a medical condition with the request for reimbursement.

Note: The cost of an abdominoplasty such as a Tummy Tuck is not eligible if the sole purpose is to enhance appearance.

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How Health Plans Ensure Claims and Appeals Notices Are Culturally and Linguistically Appropriate

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Health plans must communicate effectively with all members, regardless of their language. The Affordable Care Act (ACA) mandates that claims ...

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