Scalp cooling is currently a self-pay treatment. Insurance coverage for scalp cooling is not yet standard in the United States. Providers have reported that some insurance claims have been submitted to health insurance organizations and reimbursement received for scalp cooling treatment costs.
Success with reimbursement varies depending on health plan, beneficiary coverage, and geographic location. Paxman is currently engaged with a reimbursement consulting organization to assess insurance coverage for scalp cooling technologies.
The Center for Medicare and Medicaid Services (CMS) has published a National Coverage Determination (NCD) for Scalp Hypothermia During Chemotherapy to Prevent Hair Loss (110.6) information.
The NCD explains that keeping the scalp cool during chemotherapy has been noted to reduce the risk of hair loss. The cooling may be done by packing the scalp with ice-filled bags or bandages, or by specially-designed devices filled with cold-producing chemicals activated during chemotherapy. The NCD states that while ice-filled bags or bandages or other devices used for scalp hypothermia during chemotherapy may be covered as supplies of the kind commonly furnished without a separate charge, no separate charge for them would be recognized.
However, Aetna considers scalp cooling i.e., using ice-filled bags/bandages, cryogel packs, or specially designed devices, including the Paxman Scalp Cooling System, medically necessary as a means to prevent hair loss during chemotherapy.
To seek reimbursement from your health insurance plan, you should consider the following steps in your submission:
1. Obtain and complete the insurance reimbursement claim form from your insurer. You may be able to download this from their website.
2. It is useful to include a copy of the JAMA publication on Scalp Cooling with your submission. We have prepared a synopsis here. View Here.
3. You will require a letter of medical necessity from your doctor to include in your submission. Download a sample here.
4. Ask your doctor for progress notes that references you are using Scalp Cooling and include them in your initial submission along with your initial enrollment form.
5. Include a copy of your receipt for payment for the cooling cap used for treatment. You will receive your receipt from Paxman Hub.
Or you can call 8445 PAXMAN (844-572-9626)
6. Please note that health insurance coverage varies among individual health plans and may be dependent on policy coverage, location, and other factors stipulated by the health insurance provider. Depending upon health benefit design, each patient may be responsible for a portion of the scalp cooling cost. Please check with your health policy provider.