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  • ThermaZone
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insurance details

Forms

ThermaZone Insurance Form

How to Submit

Thank you for your interest in the ThermaZone® Thermal Therapy System. In an effort to help you aid your patient in obtaining reimbursement from an insurance company, it is our pleasure to share the following information. While we cannot promise that an insurance company will reimburse any patient for their purchase, we are hopeful that insurance companies will recognize the benefits of the ThermaZone® System.


WHEN COMMUNICATING WITH ANY INSURANCE PROVIDER, PATIENTS CAN CHOOSE FROM THE FOLLOWING APPROACHES:

  1. Request reimbursement after they have purchased the system.
  2. Pre-determine benefits before purchasing the ThermaZone® system.
  3. Appeal for reimbursement after they are initially denied by their plan.


IF THEY CHOOSE TO PURSUE OPTION 1 (POST-PURCHASE REIMBURSEMENT), ADVISE THEM TO TAKE THE FOLLOWING STEPS:

  • Purchase the device
  • Mail the following documents to their insurance carrier:
    • Reimbursement Request letter
    • Physician’s Prescription
    • ThermaZone® product receipt
    • Noridian PDAC letters
    • Evidence of Clinical benefit


IF THEY CHOOSE TO PURSUE OPTION 2 (PRE-DETERMINATION) ADVISE THEM THE FOLLOWING STEPS:

  • Call insurance provider and provide them with the following:
    • Pre-determination Letter
    • Physician’s Prescription
    • Physician’s Review Sheet
    • Noridian PDAC letters
    • Evidence of Clinical benefit
  • After receiving your pre-authorization, purchase the device


OPTION 3 – IF YOUR CLAIM HAS INITIALLY BEEN DENIED BY YOUR INSURANCE PROVIDER:

  • Do not be discouraged, and be persistent in efforts to appeal
  • To provide further argument or support for your claim, we encourage you to craft an appeal letter
  • Mail the following to your insurance company at the address indicated in your denial letter (if no address was provided, resubmit to the original address but mark it ATTN: Appeals Group)
    • Patient First Level Appeal Letter
    • Copy of Physician’s Prescription Form
    • Copy of ThermaZone® receipt (if already purchased)
    • Physician’s Review Sheet
    • Evidence of Clinical benefit

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Manufactured by Innovative Medical Equipment, LLC

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