Insurance, Medicare, and Medicaid Coverage

Jasmine Schmidt Health Guide April 22, 2008
  • Using products to manage incontinence can take its toll financially. Working your way through the world of Medicare, Medicaid, or private insurance can be confusing, and unfortunately all too often it ends up fruitless, but there is much work that we can all do to push towards improvement in the system.

     

    Private Insurance Coverage of Incontinence

    To the best of my knowledge, there is no federal legislation mandating that insurance companies cover adult absorbent products, and in more than one case I've been told stories of insurance companies refusing coverage because the products aren't (in their words) "medically necessary". It's always worth checking with your insurance provider because a simple phone call may reveal that they do actually cover these costs, but be prepared for the answer to be no.

     

     

    When ordering products from a mail-order service, you can inquire whether or not they will bill your insurance company. (Keep in mind that in the case of an HMO, you may need to order your supplies from a specific vendor.) Either way, obtain a detailed receipt that you can submit to your insurance carrier for a reimbursement. Even if it is your insurance company's policy to not offer reimbursement for absorbent products, you might consider sending in the reimbursement form anyhow so that they are aware of the need. Of course, I encourage each and every one of you to write a letter to the president of your insurance company urging them to cover these vital supplies!

     

    Medicare Coverage of Incontinence

    Medicare coverage varies from state to state, but there is a fairly easy-to-use website where you can check coverage in your particular state (in fact, you can even check your individual coverage by entering your ID number). To check coverage of urinary incontinence supplies in your state, simply go to http://www.medicare.gov/Coverage/Home.asp and select your state, and then choose "Urological Supplies" from the list of topics.

     

    Coverage of "Urological Supplies" generally includes "urine collection devices", such as catheters and condom catheters. Unfortunately, absorbent products aren't considered a urine collection device (which I can't understand, seeing as how, technically, that is exactly what they do). Also, sadly, the coverage for the products that are included is mediocre, at best, and not enough catheters are provided monthly, leading to health problems such as urinary tract infections (which, as we all know, can lead to even bigger problems).

     

    One option for men to look into is using condom catheters rather than absorbent products, since those may be covered. Women, I urge you to start writing letters (again) since there isn't an equivalent available for us, so absorbent products - which aren't covered - are often the only option.

     

    Medicaid Coverage of Incontinence

    Medicaid coverage, like Medicare, varies from state to state. In some states, Medicaid recipients are eligible for complete coverage of absorbent products. Often the company you order products from can help you figure out if Medicaid will cover your products in your state (assuming you are a Medicaid recipient).  In some states, Medicaid has "preferred vendors" who you must order your products through, so you may also find it helpful to call your state Medicaid office directly for help.

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    Sadly, there is no clear-cut answer as to what exactly is covered, by whom, or for what amount, so each individual is left to figure it out on their own. But a short phone call (and even the risk of speaking to some unhappy and less-than-helpful phone operators) could be worth the possible savings. More importantly, keep your eye on the "long-run", as that's when we're more likely to see changes as the result of our letters and phone calls. It's not a perfect system... yet (says the ever-optimistic me)!

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