Your letter handoff, step by step
Check off each step once you have the accurate record in hand. A checkmark is not medical necessity and it does not predict what your plan decides.
Privacy: Your checkmarks stay in this browser on this device; SteadySkin never sees them. Keep the letter and every health or insurance document in your plan’s or clinic’s approved secure channel, not typed in here.
- Owner
- Health plan, with you or your authorized representative
- Proof to keep
- Current benefit document, policy, request description, and official instructions
- Ready when
- Your clinical office now has what the plan is actually asking for
- Next action
- Ask your clinician which parts of your record are relevant and accurate
- Owner
- Treating clinician
- Proof to keep
- The clinician owns the professional conclusion and its wording
- Ready when
- You, a supplier, or a website are not standing in for the clinician’s judgment
- Next action
- Reconcile your current record and fill in any missing clinical facts
- Owner
- Clinical office for medical records; supplier or billing office for item details
- Proof to keep
- Accurate clinical record plus the exact product, supplier, order, and billing information
- Ready when
- Each party has supplied the facts only they can supply
- Next action
- Submit through the plan’s official route and keep the confirmation
- Owner
- You or your authorized representative, with the health plan
- Proof to keep
- Complete written approval, request for more information, or denial notice
- Ready when
- You can see the reason, what is missing, the review route, and the deadline
- Next action
- Respond to exactly what the decision says, without guessing at the reason
Who should write the medical-necessity conclusion?
Your treating clinician writes and signs it, not you, a supplier, or a website template. You can make sure your record is complete; the clinical judgment itself has to come from them. Evidence Evidence
Why this item matters
- Sources cited, not yet graded
I read the CMS order requirements and Anthem’s home ultraviolet-device policy. Order forms from equipment suppliers ask about the product, not about you personally. Plan policies keep patient-specific review with your clinician, not the supplier.
Check before moving on
- Depends on you
The exact title, format, and required signer can vary by plan and request. A supplier can help assemble paperwork, but that does not make them the clinical author.
For your dermatologist’s office
Do you want the plan’s written policy from me before you draft the letter, or will your office request it directly from my insurer?
Saving keeps this on your device and needs JavaScript, which is off in this browser.Have we recorded the treatments I tried before this and how they went?
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What does the letter usually have to cover?
Four criteria show up across more than one of the plans whose policies are sourced here. Ask your clinician which ones your own chart already documents. Evidence Evidence Evidence Evidence Evidence
- Proof you already tried another treatment.
- A note that a dermatologist is supervising or prescribing it.
- A stated reason office or clinic phototherapy will not work.
- A prescription for a specific, FDA-cleared device.
Why this item matters
- Sources cited, not yet graded
Anthem and Premera both require records showing another treatment was tried before home UVB. Both also name a dermatologist as the one supervising or prescribing it. Aetna and Premera both require a reason clinic phototherapy will not work, such as distance or how often treatment is needed. Both also limit the benefit to a prescription for a specific, FDA-cleared device. Anthem separately requires scheduled follow-up exams and an expected minimum length of treatment.
Check before moving on
- Depends on you
UnitedHealthcare and Cigna do not publish home-specific medical criteria at all. UHC only lists which device codes need prior authorization above a cost threshold, and Cigna reported removing its home-phototherapy coverage statements. A criterion listed here for one plan is not automatically part of every plan’s rule; your own plan’s current document still controls.
How should your plan’s current rule shape the letter?
Hand your clinical office the exact request, your plan’s current document, and its official instructions. Ask them to address only the criteria your own record actually supports. Evidence Evidence Evidence
Why this item matters
- Sources cited, not yet graded
I compared Premera’s individual-plan policy with the federal plan-document guidance. Home-phototherapy coverage rules differ from plan to plan on condition, prior care, supervision, follow-up, device, and product requirements. Whatever your plan currently has on file controls, not a generic policy you found online.
Check before moving on
- Depends on you
A public carrier policy may not be the one governing your specific plan, especially if your employer self-funds it. Do not let a criterion from someone else’s request end up in your record.
For your plan
Which policy document governs my request, and is my plan self-funded?
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What belongs with the clinical letter, and what does not?
Keep your clinician’s medical record separate from the paperwork trail: the exact item, order, supplier, product identifiers, billing information, and reference number. Confirm with each party who is supplying which piece. Evidence
Why this item matters
- Sources cited, not yet graded
A device or supply request can need both standardized order details and your specific clinical record. A missing supplier detail can stall your request even when your clinical record is complete.
Check before moving on
- Depends on you
What has to be attached, and who submits it, differs by plan. Do not send health records over ordinary email or a public form when your plan or clinical office offers a secure route instead.
For the supplier
What do you need from the prescriber versus from me?
Saving keeps this on your device and needs JavaScript, which is off in this browser.What is the reference number for this order?
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Does a complete letter guarantee you get approved?
No. A complete letter helps your plan review the real request. It does not create a benefit, override an exclusion, guarantee authorization, or promise payment. Evidence Evidence
Why this item matters
- Sources cited, not yet graded
People I have heard from are told their skin condition is cosmetic and that the plan will not pay. Coverage decisions can turn on benefit terms, medical policy, authorization, network status, supplier eligibility, coding, and the record you submitted. A written decision should tell you the actual reason and how to respond.
Check before moving on
- Depends on you
Only your plan can decide your request under its own rules. If a denial raises a time-sensitive or legal question, follow the notice’s instructions and get qualified help instead of relying on a generic letter.
For your plan
Will you send the decision in writing, with the reason and the review route?
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Questions that can change the next decision
For your health planWhich current policy and patient-specific records apply to this exact request?
Saving keeps this on your device and needs JavaScript, which is off in this browser.For the clinical officeWould the treating clinician author the medical-necessity conclusion from my current record?
Saving keeps this on your device and needs JavaScript, which is off in this browser.For the supplier or billing officeWhich product, supplier, order, and billing details must accompany the clinical record?
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Evidence behind this page
Sources
Each evidence badge opens the source and its limits. The full list stays available here.
- U.S. Centers for Medicare & Medicaid ServicesRegulatory · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports distinguishing fully insured from self-funded employer coverage and identifying the plan or employer as the source of that answer.
What it does not support
It does not interpret a plan document, establish a benefit, or make a carrier medical policy controlling for a specific member.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- Anthem / Elevance HealthPayer policy · Regulatory / guideline, tier 1Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports Anthem-family criteria for home UVB in psoriasis and vitiligo, including prior topical treatment, physician supervision, scheduled review, and expected long-term use.
What it does not support
The member contract and affiliate implementation control; the policy does not state prior-authorization, supplier, price, or rental terms.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- Aetna / CVS HealthPayer policy · Regulatory / guideline, tier 1Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports Aetna’s public home-UVB DME criteria for severe psoriasis with frequent flares and stated access or prompt-treatment circumstances, and directs vitiligo readers to CPB 0422.
What it does not support
It does not guarantee coverage or state supplier, authorization, price, or rent-versus-purchase terms.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- Premera Blue CrossPayer policy · Regulatory / guideline, tier 1Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports current Premera Individual Plan criteria for severe, extensive, refractory vitiligo, dermatologist prescription and records, FDA-cleared UVB-only equipment, appropriate size, ability to follow instructions, and stated access or cost circumstances.
What it does not support
It does not apply to every Premera or Blue plan or publish authorization, supplier, or rental terms.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- UnitedHealthcarePayer policy · Regulatory / guideline, tier 1Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the finding that UHC’s current public national commercial light-and-laser policy does not state condition-specific home-UVB device criteria for vitiligo or psoriasis.
What it does not support
Absence from this document is not an approval or exclusion, and product, state, code-level authorization, DME, supplier, and benefit rules may differ.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- Cigna HealthcarePayer policy · Regulatory / guideline, tier 1Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports Cigna’s statement that home-phototherapy coverage positions were removed because the associated codes were no longer clinically managed.
What it does not support
That statement is not an approval, exclusion, benefit promise, supplier rule, or current condition-specific criterion.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- U.S. Department of Labor, Employee Benefits Security AdministrationRegulatory · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports that participants in ERISA-covered plans receive or may request important plan documents, including the summary plan description, and that written requests can matter.
What it does not support
It does not apply identically to every coverage regime, interpret a specific plan, establish coverage for phototherapy, or provide legal advice.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- HealthCare.gov, U.S. Centers for Medicare & Medicaid ServicesRegulatory · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports a general US individual and group health-plan distinction between internal appeal and eligible external review, and the need to use the denial notice for instructions.
What it does not support
Rights, deadlines, urgent pathways and external-review availability vary by plan and jurisdiction, so this source does not supply a universal deadline or guarantee review.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- U.S. Centers for Medicare & Medicaid ServicesRegulatory · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports current Medicare context that DMEPOS orders use standardized elements and that supporting documentation is beneficiary-specific.
What it does not support
It does not establish that a home phototherapy device is covered, identify a code, apply to commercial plans, or replace the current plan and supplier requirements.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.