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Thread: United Health Care and catheters

  1. #1

    United Health Care and catheters

    Hey all, hope everyone is okay and as healthy as possible. Just started my new job and insurance is through United Health. Urinary catheters are exempt from the plan for some reason; other than that it seems pretty awesome. I told my HR lady (very helpful woman, btw) that this is basically the only real cost I face and that it would be nice to have it covered since it's not a temporary need, but an ongoing medical necessity. She informed me that she wanted a code, or something of that nature. I am coming from Kaiser northern California which basically covered my caths, however now that I am in Rhode Island, I won't have Kaiser anymore, unfortunately.

    So, does anyone here have United Health Care for their insurance and also have their urinary catheters covered? If so, any idea what the insurance code is for caths?? Thanks to any and all for any help!
    No one ever became unsuccessful by helping others out

  2. #2
    The codes for catheters and diagnosis are the same regardless of insurance plan.

    Hope this helps:

    Healthcare Common Procedure Coding System ( HCPCS) codes for intermittent catheters are:

    A4353 (Sterile Intermittent Catheter Kit)
    A4351 (Straight Tip Intermittent Urinary Catheter)


    Some ICD 10 ( International Statistical Classification of Diseases) diagnostic codes associated with urinary catheter DME include:

    N31.9 Neuromuscular Dysfunction of the bladder NOS
    N39.3 - N39.498Stress and other specified urinary incontinence [expected to be 3 months duration or more]
    R32Unspecified urinary incontinence [expected to be 3 months duration or more]
    R33.0 - R33.9Retention of urine [expected to be 3 months duration or more]

    Last edited by 2drwhofans; 08-28-2015 at 04:51 PM. Reason: spelled out abbreviations

  3. #3
    You can appeal this denial, and you have the right to request that your appeal by reviewed by a physician who has a specialty you specify. For example, you could specify a physician who is board certified in PM&R and/or Spinal Cord Medicine, or one who is board certified in urology. Remember at this point you are dealing only with some clerk who is going by some manual or handbook and does not have the experience or education to understand what the medical necessity is.

    Also, keep in mind that insurance policies differ from state to state, so what is covered by UHC in one state may not apply to another state.

    (KLD)

  4. #4
    It's not a denial.

    It appears that some UHC plans specifically exclude intermittent catheters and have been doing so for years. Here's the latest UHC policy. See page 6, item 21.

    https://www.unitedhealthcareonline.c...ies/DME_CD.pdf

    A CareCure Member was having difficulty with this same thing last year and another in 2009:

    http://sci.rutgers.edu/forum/showthr...ited+catheters

    http://sci.rutgers.edu/forum/showthr...over-catheters

    I have no ties to this DME company, but they were alerting their customers to the change last year:

    http://summitexpressmed.com/urgent-n...tionnew-trend/

    Is there another healthcare insurer at your workplace? Is there another level or plan type from UHC that may not exclude catheters?

    Hopefully the HR lady can work it out.
    Last edited by 2drwhofans; 08-28-2015 at 08:57 PM.

  5. #5
    Quote Originally Posted by 2drwhofans View Post
    It's not a denial.

    It appears that some UHC plans specifically exclude intermittent catheters and have been doing so for years. Here's the latest UHC policy. See page 6, item 21.

    https://www.unitedhealthcareonline.c...ies/DME_CD.pdf

    A CareCure Member was having difficulty with this same thing last year and another in 2009:

    http://sci.rutgers.edu/forum/showthr...ited+catheters

    http://sci.rutgers.edu/forum/showthr...over-catheters

    I have no ties to this DME company, but they were alerting their customers to the change last year:

    http://summitexpressmed.com/urgent-n...tionnew-trend/

    Is there another healthcare insurer at your workplace? Is there another level or plan type from UHC that may not exclude catheters?

    Hopefully the HR lady can work it out.
    Thanks, 2drwhofans. I don't think there is another provider at work. I will update when I see what transpires from all of this, but I'm giving myself a 30-70 probability that these will be exempted...we'll see.
    No one ever became unsuccessful by helping others out

  6. #6
    Why not make a call to the DME company linked above. Maybe they know a way around the exclusion. It can't hurt to ask.
    Last edited by 2drwhofans; 08-31-2015 at 06:56 PM.

  7. #7
    I have United Health Care and have also been told no catheters or lubricant are covered. None of the UHC health plans within our company cover them.
    Last edited by kurtsang; 09-01-2015 at 08:42 AM.

  8. #8
    So I finally heard back from my HR lady and she told me that they are going to cover the exact number of catheters that I had covered under my Kaiser plan. What I had covered by Kaiser was 270 catheters for every 3 months which is exactly what I've always needed. Here's the caveat - I am a professor at a private university where we pretty much get whatever we want, so I am not exactly sure what really happened behind the scenes so that I could formulate a plan to have others repeat my success. Here is some information/facts, though:
    - I started my coverage with United during the campus-wide open enrollment period.
    - I don't really use that many catheters and purchase my own lube (I use Vetericyn VVF hydrogel) and the ones I do use are pretty cheap - 80 some-odd cents a pop.
    - I really bitched about how ironic it would be if the insurance I had while I was essentially on the public dole was better than the policy I ended up with as my first tenure-track academic job (this was about 3 separate emails).
    - I specified that I wanted information on how to continually appeal if the urinary catheters weren't covered.
    - The HR woman we have here is phenomenal.

    Here is what I think happened:
    - Within the policy itself, there's probably a set number of random "blank" fields for items which aren't exactly the easiest to classify...these are items which fall in the gray areas and thus can be placed into one bin (covered) or another (not covered) essentially at the behest of the policy administrator.
    - My guess is that my 270 urinary catheters per 3 months are not referred to as such if one were to look at my specific policy, and thus were literally forced into covered status.

    Again, I am a macroeconomist and not an insurance guy, so I may be waaay off here.

    I know this doesn't really help any of you per se, but I wanted to update all of you as to what the ultimate result in my case was.
    No one ever became unsuccessful by helping others out

  9. #9
    Hey Professor! Congratulations on your University coming through.

    ps: Only an Economist could have written this... "Within the policy itself, there's probably a set number of random "blank" fields for items which aren't exactly the easiest to classify...these are items which fall in the gray areas and thus can be placed into one bin (covered) or another (not covered) essentially at the behest of the policy administrator."



  10. #10
    Quote Originally Posted by Tufelhunden View Post
    So What I had covered by Kaiser was 270 catheters for every 3 months which is exactly what I've always needed.
    You only pee 3 times a day? I need 180 a month and i still end up buying an extra 30 or so every couple of months.

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