Illogical Insurance

I finally remembered to visit the benefits website at work today. I wanted to find out whether or not Intense Pulsed Light treatment for rosacea is covered under my health insurance. I didn't think it was, but I figured I'd check anyway.

The Member's Handbook stated that cosmetic procedures other than those medically necessary are not covered. Well, how is "medically necessary" defined?

So I call up Keystone and ask. Well, they can't really define "medically necessary" in this case, either. Rosacea is a known medical condition, but it's also cosmetic. So the guy, who I have to admit was quite helpful, looked up this specific treatment. The verdict? Intense Pulsed Light treatments for the redness of rosacea are not considered medically necessary.

Ok - it was a longshot, anyway. But then, I started thinking about it, and it just doesn't make sense. The IPL treatment will run me around $1500 or so. Going the non-IPL route, insurance will cover my dermatologist visits, in addition to the assorted creams, gels, and antibiotics for rosacea treatment. Now, if I'd add up the cost of just one of the gels I've tried (which unfortunately didn't work), then figure I'd have to be supplied for the rest of my life to keep the redness away, seems to me the Big Bad Insurance Company isn't too good at doing math. Compound that with the fact that my rosacea will most likely get worse as I get older - more redness, more lumps, bumps, and swelling - which may require additional creams, gels, or drugs... I'm no math whiz myself, but wouldn't it be cheaper for them to just cover the IPL treatments? Hell, the cost of therapy could even be added to that ongoing cost - in a couple years, I'll have such a damn complex about my face that I won't even want to be seen in public. Ok, it won't be that bad - but looking at my dad and brother, who continuously appear to have baked in the tropical sun for a long period of time - it may not be too far off! If that's where I'm headed complexion-wise, then I'll be headed for psychological help soon after.

I know IPL treatments won't cure my rosacea - but I've read several accounts of people feeling like they had a new face aftewards.

Another option may be using a Flexible Spending Account to pay for the treatment, but again, there seems to be some ambiguity in the text. I'm allowed to use my FSA for cosmetic procedures to correct "disfigurement" from disease, congenital problems, or surgical complications (at least I don't have to worry about having part of my nose missing because of that damn bump). Well, if I let the rosacea go, my face could get a little "disfigured", no? Why wait until it's too late?

So I call Cigna, the administrator of our FSA plan, and according to them, it "should be covered". Hmmm. So basically, I can stick $1500 in an FSA, wait to see if it's covered, maybe find out it's not, then have to shell out another $1500 to pay for the IPL, then lose the $1500 I put into the FSA.

That's not smart math, either.

I'm hoping the billing people at the dermatologist's office can help me sort this out when I go in next week.