Payment and insurance options

When it comes to undergoing a medical procedure, cost matters. Understanding those costs, along with your insurance benefits and coverage options, can help you be prepared. For tips and guidance on next steps, select the option below that best aligns with your current situation.

I have commercial insurance

I have Medicare / Medicare Advantage

I have Medicaid / Managed Medicaid

I am paying without insurance

Frequently asked questions

To determine if you have insurance coverage for a male sling procedure, review your insurance policy documents or contact your insurance provider directly. Check for details such as coverage limits, deductibles, and covered services or events. If you’re unsure, your insurance agent or representative can provide clarification. In addition, our Reimbursement and Benefits Team can assist you with understanding if you have coverage: 1-855-230-7611.

“Medically necessary” refers to healthcare services or treatments that are deemed essential to diagnose, treat, or manage a patient’s medical condition or symptoms.

For insurance companies, determining medical necessity helps control costs by ensuring that coverage is provided only for services that are essential for a patient’s health.

For patients, it’s important because many insurance plans, including some Medicare Advantage plans, will cover a male sling if it is deemed medically necessary by your healthcare provider.

A male sling may be considered a medically necessary treatment for you depending on the reason for your incontinence.

This process requires healthcare providers to obtain approval from the insurance company before performing a specific treatment, procedure, or prescribing a medication.

It ensures that the proposed service meets the insurer’s criteria for coverage, including medical necessity and appropriateness.

Some insurance plans, including some Medicare Advantage plans and Medicaid coverage in some states, may require prior authorization request before providing coverage for a male sling procedure.

There are a few reasons why your health plan may deny your proposed treatment, including:

  • Services are not considered medically necessary or appropriate in a specific healthcare setting or level of care
  • The health plan considers the treatment to be investigational, experimental or unproven
  • The service requested is not a covered benefit under the plan

You have the right to file an appeal. This is when you ask for a full and fair review of the decision, aiming to overturn the denial and obtain approval for the procedure. Insurance plans often have multiple levels of appeal.

Appeals give you the opportunity to present additional information, such as medical evidence or documentation, to support the necessity and appropriateness of the requested service, with the goal of securing coverage.

This checklist can help guide you and your physician’s office in sending a complete and thorough appeal request to the insurance company: Appeals Checklist

If your state has a Consumer Assistance Program, they may also help file an appeal on your behalf.

In addition, our Reimbursement and Benefits Team can assist you and your physician with the appeals process: 1-855-230-7611.

compass-icon

Need help navigating the process?
Talk to an expert.

Navigating insurance benefits and coverage options can feel overwhelming. If you have questions about insurance coverage, our Reimbursement & Benefits Support Team is here to help. We’re available 9am-4pm CST. Give us a call today.

pin-icon

Find a local doctor

If you are ready to talk to a doctor about the possibility of receiving a male sling, use our physician directory to find a qualified urologist specializing in incontinence near you. They can answer your questions and help you take the next step toward taking back control of the lifestyle you want to live.

References

  1. How Do I File an Appeal? Medicare.gov. https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal. Accessed June 2024.
  2. What Medicare Covers. Medicare.gov. https://www.medicare.gov/what-medicare-covers. Accessed June 2024.
  3. Medicare and You Handbook. Medicare.gov. https://www.medicare.gov/publications/10050-Medicare-and-You.pdf. Accessed June 2024.
PM-33596