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Medicare covers 80%. The patient must have a four week trial of pelvic muscle exercises.
United Health- it depends on the patients DME coverage. Usually a deductible needs to be met.
Kaiser Northern California- Definitely for their Medicare patients and depending on clinical review for others
Aetna- Covers PMT’s depending on DME coverage.
Health Choice- they cover between 20%-50% after deductible is reached
Blue Shield- Cover’s PMT’s depending on DME coverage.
If your patient would like to check if her insurance plan covers the Athena PMT here are some questions to ask:
-Do I have DME (Durable Medical Equipment) coverage with my plan?
-What is my deductible both in and out of network?
-How much of my deductible have I met both for in and out of network?
-The HCPCS (Hicpic) code is E0740. Is that a covered code?
-Does this require a pre authorization, if so where do I send that, what information do you need, and how long will it take to receive a determination.
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