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Private Insurance can be individually purchased but is often provided through employer-sponsored health benefits. Catheter reimbursement is individually determined and/or policy determined. It is important for you to know what your insurance provider will cover.
Will your catheters be covered at 100%?
Is there an annual limit for coverage?
Is there a co-pay? Often, insurance covers 80% and you must pay the remaining 20% either out of pocket or by coordinating co-pay with your spouse’s insurance.
Prior approval is typically required and a request for reimbursement may also require the following:
Doctor prescription, either with the first claim or with each individual request (ask your provider)
Doctor support letter stating the diagnosis and reason why and how frequently you need to use a catheter
Official receipt from pharmacy or dealer to submit to your insurer for reimbursement. You can also ask your pharmacy / dealer if they can bill your insurer directly.
Coloplast Intermittent Catheter Letter of Recommendation
Coloplast provides this information for convenience and your general reference only. It does not constitute legal advice or a recommendation regarding clinical practice. Reimbursement, coverage and payment policies can vary from one insurer and region to another and is subject to change without notice. The provider has the responsibility to determine medical necessity and to submit appropriate codes, information, and charges for care provided. Coloplast does not guarantee coverage or payment of products and Coloplast makes no guarantee that the use of this information will prevent differences of opinion or disputes with providers, agencies, insurers, or other payors as to the correct form of billing or the amount that will be paid. This information is provided for your general information only and is not intended to replace any advice you receive from your own internal or external insurance coverage consultants, reimbursement specialists or legal counsel.
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