It is important that you get the intermittent catheter that best meets your specific medical needs. An intermittent catheter that is both comfortable and convenient to use helps you to maintain the intermittent catheterization regimen prescribed by your healthcare provider. Adhering to that prescribed regimen is vital for your overall health maintenance and quality of life.
Besides manufacturing catheters, our Coloplast® Care team can assist you in finding the right catheter and a supplier that can deliver it.
Here are the steps on how to get your catheters:
Step 1: CHOOSING YOUR INTERMITTENT CATHETER
You and your physician/clinician will decide which type of intermittent catheter best meets your specific medical needs.
Step 2: WRITING THE PRESCRIPTION
Your healthcare provider will then write a prescription for that intermittent catheter. The prescription must include the following information:
- Your name
- A detailed description of the required products –including type and French size of the intermittent catheter*
- The quantity of intermittent catheters you use per day and month**
- The starting date of your usage
- The medical condition requiring your use of intermittent catheters
- A signature from your physician or nurse, as well as the date that the order was signed
- The language needed (varies per state) as to “Dispense as written” or “No substitutions” or “Brand medically necessary”, etc.
* NOTE: It is important that your healthcare provider specify a particular brand name if you both have decided a particular brand (i.e. Coloplast) best meets your medical needs
** Medicare and many other insurances cover up to 200 catheters per month
Step 3: VALIDATING INFORMATION (Prescription & Insurance)
The prescription is then given to the medical supplier. They will review it to ensure it has all the required information to legally fill the order. At this time, they will most likely also verify your insurance information and contact that insurance provider to ensure they have everything they need to submit an insurance claim for the product you are purchasing.
Step 4 : FILLING THE PRESCRIPTON
The medical supplier is responsible for providing you with the intermittent catheters as prescribed by your physician (i.e.: straight tip, coudé tip, no-touch, french size, brand name, etc.)
- If your physician has not specified a specific BRAND on your prescription, the medical supplier can choose to send any type or brand of intermittent catheter.
- If your physician has not specified the specific AMOUNT (times per day and month) the medical supplier can ship you up to the maximum units allowed per month. This may impact your co-payment.
- If the medical supplier tells you that certain intermittent catheters are not covered, you should consult your healthcare professional. You may also want to reach out to your Coloplast Care Advisor because he/she may be able to help you find a medical supplier that will provide you with the specific intermittent catheter you and your healthcare provider specifically chose as the one that best meets your medical needs.
Step 5: SHIPPING THE PRODUCT
The medical supplier then ships the intermittent catheters to your home. Review the shipment upon receipt to ensure you have received the product chosen by you and your physician. If anything is different, you should:
- Contact the medical supplier to discuss your concerns. Remember that:
- If no specific brand was noted on the prescription, the medical supplier can choose to send any brand of intermittent catheter
- If the number of intermittent catheters you need per day/month is not specified on the prescription the medical supplier can ship you up to the maximum allowable units your insurance policy permits, which may impact your out-of-pocket co-payment responsibility
- If the medical supplier tells you that your chosen brand or type of intermittent catheter is not covered by your insurance, contact your Coloplast Care Advisor. He/she may be able to help you find a medical supplier that will provide you with the intermittent catheter you and your physician chose as the best option for you.
- Contact your physician to discuss your concerns and confirm if the shipped product meets your needs
Step 6: SUBMITTING THE INSURANCE CLAIM
The medical supplier will submit your insurance claim, along with all supporting medical documentation, to your insurance provider.
Step 7: RE-EVALUATING INTERMITTENT CATHETER OPTIONS/NEEDS
Over time, your intermittent catheter requirements might change. If you experience frequent urinary tract infections or difficulty advancing your intermittent catheter through the urethra and into your bladder, you should contact your healthcare provider immediately. He/she will need to discuss the problem with you and address the issue accordingly. In some instances, it may be determined that a different intermittent catheter type could help.
- No-touch, sterile kit or closed systems are sometimes suggested for individuals that experience “frequent urinary tract infections”.
- Coudé tip intermittent catheters are frequently recommended for individuals who experience difficulty in advancing the catheter through the urethra and into the bladder.
NOTE: It is always a good idea to bring one of your intermittent catheters with you to your office visit. This helps remind the healthcare provider of what you are currently using and can help in the discussion of finding other options for you based on the issues you are experiencing.
Finding a supplier:
The Coloplast Care Team may be able to help direct you to a medical supplier that accepts assignment of your insurance. This means:
- The medical supplier will fill your prescription and file an insurance claim on your behalf.
- Your insurance provider will allow a certain amount of money for each product unit purchased (NOTE: this is usually, but not always. lower than the suggested retail price) An example might be that a suggested price for the catheter is $3.00 but the ALLOWED amount by the insurance is only $2.00
- Depending on your insurance, you may be responsible for part of that allowed amount. Using the above scenario as an example with Medicare, it would look like this:
- Medical supplier submits insurance claim for $3.00 per unit
- Medicare ALLOWS only $2.00 per unit
- Medicare will pay the medical supplier 80% of that ALLOWED amount = $1.60 per unit
The Medicare patient would be responsible for paying the 20% of that ALLOWED amount, or $0.40 per unit (unless there is a secondary insurance policy that is responsible for covering the co-payment).
Read more in Rights & Reimbursement.
Let us help you find a medical supplier that accepts assignment for the product of your choice. Call us at 1-855-863-3907.
These are general guidelines meant to help you with typical questions. You should follow the specific instructions provided by your healthcare provider and the intermittent catheterization solution you are using.