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CWI Medical
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Insurance & Reimbursement

Medicaid  | Flexible Spending Accounts (FSA)   |  Helpful Organizations   |  Medicare & Private Insurance

                                   

Medicaid Coverage

CWI Medical does not bill insurance, however depending on your location and insurance, you may be eligible for reimbursement. Contact your healthcare provider or Medicaid for more information on how to obtain your reimbursement. Eligibility for incontinence supplies may be available if you are already signed up with Medicaid (including a Medicaid-Waiver or Medicaid Health Plan for adults).

Most states cover the following disposable protective products and supplies on a monthly basis:

Some states also cover:

Each state operates a Medicaid program that provides health coverage for the elderly, people with disabilities, and lower-income people, families, and children. The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults at a certain income level who have children.

There are many types of people or families who may be eligible to receive Medicaid. Some of these categories of eligibility are low-income families with children, low-income people with disabilities, and foster children. Medicaid services offered in your state for people who are “categorically eligible” may vary.

Coverage varies by state and is subject to change.

We recommend that you work with a Medicaid-registered Home Medical Supplier that can make recommendations on the products covered in your state, ship products to your home, and handle the billing for you. If you qualify, ask for the Prevail® brand. You have a choice in asking for the brand and quality of products that you think suit you best. For a list of Home Medical Suppliers that may be able to help you find out if you are covered for absorbent incontinence supplies.

Click here to purchase Incontinence products

Healthcare reform is in the process of expanding.

To see if you or a loved one qualifies for Medicaid click here - Medicaid.gov.

The Affordable Care Act is impacting Medicaid coverage.

Please click here for more information – http://kff.org/health-reform/.

 


                                 

Flexible Spending Accounts (FSA)

You can also use a flexible spending account (FSA) to purchase incontinence supplies, but always contact your healthcare provider and/or insurer to confirm which products are covered before buying. Check with your employer for more details and to learn more about your participation in FSA accounts.

FSA Guidelines

If your private insurance plan does not pay for incontinence supplies, you may be able to use flexible spending account funds to cover the costs. Disposable incontinence products that are used to relieve the effects of a diagnosed medical condition are generally covered by medical FSAs. Check with your employer or FSA administrator for more details on which medical expenses are covered by your FSA.

Flexible spending accounts (FSAs) allow employees to contribute pre-tax dollars to an account set up by their employer. The employee determines how much they will spend on uninsured healthcare for the upcoming year and designates an amount to be withheld from each paycheck to fund the account. Contributions made to a flexible spending account are deducted from your pay before your federal, state, or social security taxes are calculated, so that income is not reported to the IRS. Therefore, you decrease your taxable income and increase your spendable income. Employees can withdraw funds tax-free throughout the year to pay for qualified out-of-pocket medical costs.

 

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Helpful Organizations

Across the U.S., there are organizations dedicated to helping you healthfully handle an LOBC experience. From product recommendations to treatments and beyond, these organizations will empower you with information and support.

 

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Medicare & Private Insurance

CWI Medical does not bill Medicare or other insurance companies directly; however, by the following these steps you may be able to receive up to 80% reimbursement on certain products (see qualifications below). Please note that these guidelines apply generally but do not constitute a guarantee of reimbursement approval. For exact eligibility information please contact Medicare or your insurance provider directly.

In cases of eligibility, to secure reimbursement you will need to submit a doctor’s prescription for the item ordered; proof of delivery, such as a packing slip or shipping receipt; and, in some cases (for Medicare reimbursements), Form 1490.

Eligible products for reimbursement
Medicare eligibility requirements vary from product to product. Therefore, please read the guidelines below to determine whether your specific product qualifies for Medicare reimbursement. For other insurance providers, please contact the company directly to ascertain their policy for each item.

Power Wheelchairs and Mobility Scooters 
To qualify for a power wheelchairs and mobility scooters reimbursement, a patient must meet the following criteria:

  • The patient must suffer from mobility-related limitations on daily living activities, such as eating, bathing, dressing, etc.
  • The condition being addressed by the mobility device must be the exclusive cause of the above limitations, (for example, not by vision or cognition impairments), unless these can be addressed through caregiver support. (Please note: To qualify for a power wheelchair, it must be demonstrated that the added features of this device would be critical in helping the patient perform one or more of the above mobility-related daily living activities.)
  • Simple devices such as a cane, walker or manual wheelchair would not sufficiently address the mobility limitation.
  • The patient demonstrates an ability to operate the device safely. (For a scooter, this includes possessing the necessary strength and postural stability.)
  • The patient’s environment must allow for the use of a power wheelchair or scooter in all places where the mobility-related activities of daily living normally occur (i.e., kitchen, bedroom, bathroom).

Lift Chairs 
To qualify for a lift chair reimbursement, a patient must meet the following criteria:

  • Patient must suffer from major arthritis of the hip or knee, or from a severe neuromuscular disease.
  • Patient must be incapable of reaching a standing position on his/her own from a standard armchair in his/her home. (Please note: Medicare does not qualify a patient who has difficulty rising from an arm-less chair, particularly a low one, but could rise on his/her own from a raised chair or one with arms. The chair lift reimbursement covers only those who cannot rise at all from an arm chair.)
  • Once standing, the patient must have the ability to walk.

Note that, even in qualifying cases, Medicare covers only the seat-lift mechanism itself (typically up to $300, depending on the state). In addition, the patient’s attending physician for the condition under treatment must also be the prescribing physician for the chair lift.

Bathroom Safety Aids 
Unfortunately, Medicare will not reimburse for most bathroom safety aids. However, patients that are unable to access their bathroom may qualify for bedside commode as well as patients with a qualifying diagnosis may be eligible for a rehab shower commode chair.

 

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Related Articles

<  The Importance of Properly Sizing Incontinence Products

<  The Importance of Skin pH

<  What is Incontinence?

<  Managing Caregiving: Techniques That Can Help  

 

For recommendations for a Provider, please call us at 1-631-753-8390 or email us.

 

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