Insurance Forms

Disclaimer: This Information is a general reference and is intended to assist the physician or provider in obtaining reimbursement for health care services. This is for informational purposes only. Nothing herein shall be construed as a statement, promise or guarantee regarding levels of reimbursement, payment or charge. Furthermore, all codes provided herein are for information purposes only, and shall not be construed as a statement, promise or guarantee that these codes are accurate or reimbursement will be received. The ultimate responsibility for correct coding lies with the physician or provider.


Insurance Reimbursement Guide:

Most major insurance companies now authorize or reimburse the purchase of bright light therapy equipment if the following documents are properly submitted. If it is for authorization please contact us for a quotation invoice.

It is recommended for a person to submit to their insurance company:

1) Cover letter : Your own cover letter to the insurance company to include all pertinent member information: policy number, referring physician and personal description

Click to download the Word Document

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Cover Letter Template

2) Prescription : A prescription from your psychiatrist or general practitioner

3) Invoice : An invoice (or quotation) from Northern Light Technologies for the light therapy device

4) Insurance Form : The insurance form must be filled out by your psychiatrist or general practitioner

Click to download the Insurance Form in PDF format

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Insurance Form

5) Additional resources : Additional resources may include Abstracts from Professional Journals such as:

JAMA Psychiatry. 2016;73:56-63. Lam RW, Levitt AJ, Levitan RD, et al.
Efficacy of bright light treatment, fluoxetine, and the combination in patients with nonseasonal major depressive disorder: a randomized clinical trial.

Am J Psychiatry. 2005 Apr;162(4):656-62.
The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence.

Cochrane Database Sys Rev. 2005;2:CD004050. Tuunainen A, Kripke DF, Endo T.
Light therapy for non-seasonal depression.