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Catheters

Will My Insurance Cover Catheters?

Will My Insurance Cover Catheters?

Image showing stethoscope and money. Will my insurance cover catheters is a common question asked by catheter users.

Have you recently been prescribed urinary catheters? “Will my insurance cover my catheters?” is a common question for new catheter users, or for those who have recently changed insurances – and understandably so. Medical supply spending is rising in the U.S. and can rapidly become unaffordable to those who require daily management supplies such as catheters.

Below, we’ll take a closer look at catheters and how they may be covered through insurances for patients who are prescribed them.

What Are Catheters?

When patient’s have trouble emptying their bladders, catheters can be used to support and manage the issue. Urinary catheters, while they come in various shapes and sizes, are essentially soft and hollow tubes that drain urine from the bladder to a collection bag. 

There are various different styles of catheters, but the main categories are: 

Intermittent: This category of catheter is sometimes referred to as “in and out” and can include straight catheters, hydrophilic catheters, and closed system catheters. These catheters are lubricated and placed by the patient themselves or a caregiver directly into the urethra so urine can drain into a connected drainage bag or into a toilet or disposal receptacle. 

External: External catheters are more non-invasive versions of urinary catheters that can be used by both men and women. These catheters are sometimes referred to as condom catheters or female external catheters. 

Foley: Foley catheters, also called superpubic catheters, are generally placed by a healthcare professional directly into the urethra. A small water-filled balloon helps to keep the catheter positioned in place.

Will My Insurance Cover Catheters?

When patients are in need of bladder drainage support, they may be left wondering “Will my insurance cover catheters?” This is because daily urinary catheter costs can add up quickly when paying out of pocket. Fortunately, many healthcare insurances will cover some or all of the cost of catheters when they are medically necessary and prescribed by a physician. However, the way different insurances cover catheters will vary. We’ll take a closer look at this below.

Medicaid and Catheter Coverage

Medicaid is federally funded, but run by individual states; this means that each state’s Medicaid program will vary in coverage, benefits, and eligibility. According to Medicaid.gov, as of April 2021 there were 82,301,711 people receiving Medicaid benefits in the U.S. 

There are many Medicaid programs, such as Medi-Cal in the state of California, that will cover some or all of the cost of urinary catheters. Depending on your state’s Medicaid stipulations, you may be able to obtain catheter supplies through your insurance coverage. Active Life Medical can help guide you through understanding the benefits and requirements of your Medicaid plan. If you don’t have Medicaid, you can check your eligibility and learn how to apply here

Medicare and Catheter Coverage

Image showing Medicare and explanations of Part A, B, C, D. Will my insurance cover catheters is a common question asked by catheter users.

There are certain portions of Medicare health insurance that can cover catheters; Medicare Part B can be used to cover the cost of prescribed catheters when medically necessary. Generally speaking, Medicare can cover 80% of the cost of catheters. The remaining 20% of the catheter cost can be paid for out of pocket or through a secondary or supplemental insurance plan. 

There are various different types of Medicare coverage options. Some patients’ healthcare billing will go directly through Medicare, but there are also private Medicare managed care or replacement plans available to manage your benefits and coverage. Each of these coverage options will handle catheter coverage differently. If you need assistance navigating your Medicare coverage options, the representatives at Active Life Medical can help. You can also view Medicare managed care plan options here.

Private Insurance and Catheter Coverage

Each private insurance plan will handle catheter coverage in their own way. Fortunately, many private health insurances will cover incontinence supplies when prescribed by a physician. When catheter supplies are covered by private insurances, deductibles, coinsurances, and out of pocket maximums will play a large role in how much you can expect to pay out of pocket. There will also be individual stipulations on what kind of catheters and how many are covered during outlined time periods. If you are unsure about how your private insurance will cover your catheter costs, the specialists at Active Life Medical can help find out this information.

Are you covered by insurance to receive catheters at little or no cost? Contact us today to find out.

How Will My Insurance Cover Catheters That I Need?

While there are different stipulations and requirements with every insurance company, there are several things that are generally universally needed:

  • Doctor’s prescription detailing the type, kind, and quantity of catheters and supplies needed
  • Chart notes or medical records supporting medical necessity of catheter usage
  • Letter of medical necessity (LMN) or certificate of medical necessity (CMN) for supplies needed signed by a physician
For a claim to be processed for coverage with insurance companies, these aforementioned documentations (and potentially others) will be required.
 

When you’re in need of catheters and want to bill them through your insurance, it’s essential that you partner with a medical supply company such as Active Life Medical to help navigate the process. Because different healthcare plans will have different stipulations, coverages, and requirements, having an expert that understands guidelines and coverage can help ensure the process goes smoothly. 

How Active Life Medical Can Help

Here at Active Life Medical, our team of catheter experts can walk you through the process of getting your supplies billed directly and accurately to your insurance. When medical necessary and prescribed by your physician, urinary catheters are covered by most insurances. Don’t be left wondering, “Will my insurance cover catheters?” Instead, get answers from the experts at Active Life.

We will guide you through the entire process of obtaining your needed catheter supply through your insurance, including collecting necessary paperwork from your doctors, coordinating billing with your insurance, and delivering your necessary catheters discreetly right to the convenience of your doorstep. We’re familiar and skilled in understanding insurances nationwide and can help expertly guide you through getting the catheters you need covered by your insurance.

Concerned about getting the catheter brands you want? We have one of the largest selections of catheters in the industry and only work with top brands, guaranteeing that you’ll be able to obtain any different catheter types needed.  

Let us help with your catheter insurance billing needs – Give us a call at 800-319-2336 today.