What is the insurance coverage?
Insurance coverage can vary widely based on your country of residence and the type of insurance provider you carry. Many patients wonder about their eligibility for insurance coverage when they undergo a non-surgical, in-office BPH procedure. Most patients in the United States who are looking to undergo an in-office BPH procedure will have one or more of the following insurance types: Private, Medicare and Medicaid.
While private insurance coverage varies between states, insurance companies and insurance plans, most private health insurers cover Transurethral Microwave Thermotherapy (TUMT). CoreTherm therapy falls under this category, although there are some important treatment differences and benefits with CoreTherm versus older types of TUMT technologies. You should contact your insurance company and speak to your urologist’s billing team to learn more about any pre-authorizations that need to be performed.
Further, your insurer may require certain qualification criteria to be met before they cover the procedure.
Information for Medicare Patients
Medicare covers CoreTherm treatment. Because Medicare is a national payer, the requirements are the same across every state in the United States. You may speak to your urologist or call Medicare directly to learn more about the insurance process.
Medicare Advantage may have separate requirements including a pre-authorization. Please verify coverage requirements with your urologist’s billing department or Medicare.
Information for Medicaid Patients
Medicaid coverage varies between states. Therefore, if you are looking to understand your coverage options you should contact the Medicaid office in your state. You may also speak to your urologist’s billing team to learn more.
Patients seeking treatment outside the United States should consult their insurance provider or patient care coordinator directly to understand the coverage level.