Who Will Cover my Catheter Costs?

As you look for the right catheter for you, it’s important to know your rights and what catheter costs your insurance will cover and what costs may fall to you.

There are so many things to worry about when it comes to finding the right catheter system, cost shouldn’t be one of them. It’s important to know your rights when it comes to your insurance and what will and won’t be covered by your plans. 

What Your Insurance Will Need

To start, you can reach out to your insurance provider to discuss what supplies are covered under your individual policy. They’ll most likely ask you for some information, including your prescription, and will be able to explain how you can submit your claims. 

You will most likely need to provide: 

  • Your name
  • A detailed list of the required catheter supplies—including types and sizes. If a specific brand is important, specify. 
  • The quantity of intermittent catheters you plan to use daily
  • Your start date of usage
  • The medical condition that requires you to use intermittent catheters
  • A signature from your physician or nurse, including the date the order was signed. The specific language needed for the order varies by state but may need to include certain phrasing like: “Dispense as written,” “No substitutions,” or “Brand medically necessary.”

If you require a special type of intermittent catheter, you may need to get additional documentation from your healthcare provider to prove it’s a medical necessity. The same holds true if you need to use two different products (for example, one type of catheter for home use and a more compact option for travel).

What’s Usually Covered

Typically, Medicare covers 80% of your medical supply fees after you meet your annual deductible. As of 2019, the annual deductible is $185, and includes all medical costs, such as doctor’s visits, durable medical equipment, etc. That amounts to the cost of 200 catheters per month. 

It is your right (along with the advice and support of your healthcare provider) to choose the intermittent catheter that best suits your needs. Thankfully Medippy is here to help you navigate the process. Once you enroll, we’ll search our extensive network to find the right catheter that is covered by your insurance and connect you with the right provider to simplify the ordering process. Have questions? Check out our list of frequently asked questions and learn about how Medipply can help.