Medicare? Medicaid? What’s the difference?
Medicare is a federally run health insurance program that provides medical care to people over 65 who have paid into Medicare, usually through their employer, at some point in their lives.
Medicaid is a state run health insurance program that is based on financial need and is provided to individuals and families of low income. Medicaid programs have different requirements and benefits from state to state.
Will Medicare or Medicaid pay for QuickChange Wraps?
Medicare: Currently, Medicare classifies QuickChanges in the same way as adult briefs and guards and does not cover QuickChanges. We are planning on appealing to Medicare and hoping to be reclassified and reimbursable. Admittedly, this will be an uphill battle. See below on how you can help.
Medicaid: It depends on the state. Medicaid for individuals in nursing homes will supply adult diapers and other disposable, absorbent products. Most Medicaid Waivers, which provide assistance to individuals living at home or in the community, also provide assistance, typically under the category of home care supplies. However, Medicaid Waivers and rules change from state to state and in some states the program may limit the brands or quantities of product available to an individual for a set period of time. Individuals on Medicaid should check with their local Medicaid office.
QuickChange Wraps are covered under the new federal Medicaid T4545 HCPCS code released Jan. 1, 2019. We are working with state Medicaid agencies to get them to add the T4545 code to their reimbursement formulary/schedule. We will be updating this page as more states begin to add us to their approved vendor lists. Currently, South Dakota Medicaid covers the T4545 QuickChange. Florida has indicated their plan to start coverage January 2021. See below on how you can help push your state agency to cover QuickChanges.
What is UI Medical doing to get more coverage of wraps by Medicaid and by insurance companies?
Unfortunately, it is a very byzantine process that varies from state to state, often without any formal process. We are attempting to contact state agencies, but as there are no formal processes, it is slow going.
What can I do to help get Medicaid coverage for QuickChanges?
We have been told by many Medicaid agencies and insurance companies that they won’t consider covering the QuickChange until after a member/recipient has requested coverage/reimbursement, thus forcing the organization into making a decision. We need your help setting off this starting this process!
- Visit your doctor and have the Request For Prior Authorization (available to the right) filled out by the doctor’s office. Submit the form to your insurance company or to your Medicaid agency.
- Submit a request for reimbursement to your insurance company or to your Medicaid office after purchasing QuickChanges.
What is a reimbursement code?
HCPCS codes are used for billing Medicare & Medicaid patients — The Healthcare Common Prodecure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare & Medicaid beneficiaries and to individuals enrolled in private health insurance programs.
What is the QuickChange wrap reimbursement code?
The HCPCS code is “T4545”
Will the VA cover QuickChanges?
Starting July 15th, Veteran’s Administration (VA) Health Care covrs QuickChange wraps free of charge to all eligible veterans. Refills shuld be available through your VA pharmacy or the Consolidated Mail Order Pharmacy (CMOP). You will need a prescription or other statement from your provider. Please call for more information.
Private insurance plans typically do not cover incontinence supplies. As we are also akin to catheters, not just briefs, UI Medical is currently working to seek coverage with insurance plans and will continue to update this page as new developments occur. Currently, Aetna & Farallon Insurance companies cover the QuickChange wrap.
Letter of Medical Necessity/Prior Authorization Form.
To get covered, please have your doctor complete the following form(s).
A “Prior Authorization Form/Letter of Medical Necessity” is required by most insurance providers and can be approved by any doctor or provider that is aware of your medical condition. Please bring this form to your doctor.