Re: LETTER TO GET PAYMENT FOR SCULPTRA

[Guest guest]

Dear Carl

More and more third party payers are starting to pay for Sculptra. But most patients have to have doctors send letters of medical necessity to this companies. Here is a very basic one (I would love for the group to improve on this letter since I am about to edit all the contents of Facialwasting.org soon)

As you may know, Sculptra may be provided free to those with incomes under $40,000 a year, but you still have to pay $300-600 a session for doctor's fees. Some people may require 5-8 sessions, and then one a year after that...so it can be a money pit.

Other options in the US:

Silikon 1000- 800 dollars a session, 6 sessions, no patient assistance

Radiesse- 4 sessions, more durable than Sculptra, patient assistance not as good but helps some

Arterfill- expensive as hell, permanent PMMA option in the US. No assistance

These tables are good but have mistakes that I am trying to get the company that made them to edit

Be on the look out for a new and improved facialwasting.org with photos and a new page including buttock reconstruction!

************************************************

Insurance Co Name

Insurance Co Address

Patient Name

Subscriber #

Date

To Whom It May Concern:

This letter is written in regards to the medical necessity of restorative treatment for the facial deformities this patient suffers from secondary to HIV-Associated Lipoatrophy. Facial fat loss is the most devastating aspect of this condition as it can not be disguised by clothing or other means. Although the exact underlying mechanism of HIV-Associated Lipoatrophy is unknown (1), the devastating effects of this condition are known (2,3). Patients suffering from this condition are at an increased risk of depression, socially withdrawn and potentially suicidal. Furthermore, patients have even stopped their life saving HAART therapy without consultation with their physician in an attempt to stop this side effect. The implications for viral mutations, increasing viral load and worsening of patients underlying condition requiring more expensive treatments cannot be stressed enough. Treatment of HIV-Associated Lipoatrophy with Sculptra (Poly-L-Lactic Acid) has been shown to improve anxiety and depression scores (4) as well as improve patient’s quality of life as measured by visual analogue scale (5). The use of Sculptra is clearly indicated as a reconstructive procedure; that is, repair of abnormal facial structure caused by HIV or its treatment, in order to create a normal appearance.

The safety and efficacy of Sculptraâ„¢ in restoring the normal facial contours of patients suffering from HIV-Associated Facial Lipoatrophy has been evaluated by the US FDA (6). Based on the available scientific evidence (4,5), the FDA granted approval of Sculptraâ„¢ as a restorative medical device for the specific indication of HIV-Associated Facial Lipoatrophy in August 2004.

For your information. the ICD9 diagnosis code for lipodystrophy is 272.6. HIV-related lipodystrophy syndrome consists of lipohypertrophy (fat accumulation in the visceral area and dorsocervical pad) and lipoatrophy (subcutaneous fat loss in the face, extremities and buttocks).

Due to the medical necessity of this treatment and the availability of a safe and effective treatment option, pre-approval is hereby requested for treatment of this patient's HIV-Associated Facial Lipoatrophy with Sculptra.

As this approval is relatively recent, I would be happy to further educate your company on this issue in any way that you might deem helpful. Please feel free to contact me at the above office with any questions you may have.

Sincerely,

References:

1) Montessori, V. CMAJ. 2004;170:229-238.

2) J, Carruthers, A. Dermatol Surg. 2002;28:979-986.

3) ez, E. Drug Saf. 2001;24:157-166.

4) Moyle, GJ. HIV Medicine. 2004;5:82-87.

5) Valantin, M. AIDS. 2003;17:2471-2477.

6) FDA Scientific Advisory Panel 3/25/2004 Washington DC

Regards, Vergelpowerusa dot org

In a message dated 3/15/2008 10:08:11 A.M. Central Daylight Time, carls_campsite@... writes:

I do however dread getting a letter from them that says Sculptra is coincidered "cosmedic" and not covered under my plan. Has anyone had luck with Blue Cross Blue Shield???. I live in northern land. Any info would be gratfully appreciated!!!

Thanks-CarlIt's Tax Time! Get tips, forms and advice on AOL Money Finance.

[Guest guest]

Dear Carl

More and more third party payers are starting to pay for Sculptra. But most patients have to have doctors send letters of medical necessity to this companies. Here is a very basic one (I would love for the group to improve on this letter since I am about to edit all the contents of Facialwasting.org soon)

As you may know, Sculptra may be provided free to those with incomes under $40,000 a year, but you still have to pay $300-600 a session for doctor's fees. Some people may require 5-8 sessions, and then one a year after that...so it can be a money pit.

Other options in the US:

Silikon 1000- 800 dollars a session, 6 sessions, no patient assistance

Radiesse- 4 sessions, more durable than Sculptra, patient assistance not as good but helps some

Arterfill- expensive as hell, permanent PMMA option in the US. No assistance

These tables are good but have mistakes that I am trying to get the company that made them to edit

Be on the look out for a new and improved facialwasting.org with photos and a new page including buttock reconstruction!

************************************************

Insurance Co Name

Insurance Co Address

Patient Name

Subscriber #

Date

To Whom It May Concern:

This letter is written in regards to the medical necessity of restorative treatment for the facial deformities this patient suffers from secondary to HIV-Associated Lipoatrophy. Facial fat loss is the most devastating aspect of this condition as it can not be disguised by clothing or other means. Although the exact underlying mechanism of HIV-Associated Lipoatrophy is unknown (1), the devastating effects of this condition are known (2,3). Patients suffering from this condition are at an increased risk of depression, socially withdrawn and potentially suicidal. Furthermore, patients have even stopped their life saving HAART therapy without consultation with their physician in an attempt to stop this side effect. The implications for viral mutations, increasing viral load and worsening of patients underlying condition requiring more expensive treatments cannot be stressed enough. Treatment of HIV-Associated Lipoatrophy with Sculptra (Poly-L-Lactic Acid) has been shown to improve anxiety and depression scores (4) as well as improve patient’s quality of life as measured by visual analogue scale (5). The use of Sculptra is clearly indicated as a reconstructive procedure; that is, repair of abnormal facial structure caused by HIV or its treatment, in order to create a normal appearance.

The safety and efficacy of Sculptraâ„¢ in restoring the normal facial contours of patients suffering from HIV-Associated Facial Lipoatrophy has been evaluated by the US FDA (6). Based on the available scientific evidence (4,5), the FDA granted approval of Sculptraâ„¢ as a restorative medical device for the specific indication of HIV-Associated Facial Lipoatrophy in August 2004.

For your information. the ICD9 diagnosis code for lipodystrophy is 272.6. HIV-related lipodystrophy syndrome consists of lipohypertrophy (fat accumulation in the visceral area and dorsocervical pad) and lipoatrophy (subcutaneous fat loss in the face, extremities and buttocks).

Due to the medical necessity of this treatment and the availability of a safe and effective treatment option, pre-approval is hereby requested for treatment of this patient's HIV-Associated Facial Lipoatrophy with Sculptra.

As this approval is relatively recent, I would be happy to further educate your company on this issue in any way that you might deem helpful. Please feel free to contact me at the above office with any questions you may have.

Sincerely,

References:

1) Montessori, V. CMAJ. 2004;170:229-238.

2) J, Carruthers, A. Dermatol Surg. 2002;28:979-986.

3) ez, E. Drug Saf. 2001;24:157-166.

4) Moyle, GJ. HIV Medicine. 2004;5:82-87.

5) Valantin, M. AIDS. 2003;17:2471-2477.

6) FDA Scientific Advisory Panel 3/25/2004 Washington DC

Regards, Vergelpowerusa dot org

In a message dated 3/15/2008 10:08:11 A.M. Central Daylight Time, carls_campsite@... writes:

I do however dread getting a letter from them that says Sculptra is coincidered "cosmedic" and not covered under my plan. Has anyone had luck with Blue Cross Blue Shield???. I live in northern land. Any info would be gratfully appreciated!!!

Thanks-CarlIt's Tax Time! Get tips, forms and advice on AOL Money Finance.