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Question regarding Federal Blue Cross Blue Shield catheter coverage

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  • Question regarding Federal Blue Cross Blue Shield catheter coverage

    Hi all. I am wondering if anyone on the site may be a federal government employee with Blue Cross Blue Shield coverage who know about coverage of catheters. I am about to accept an offer for employment but need to try to figure this out first. I currently work for the state of CT and have Anthem BCBS and they pay 100% for my catheters and I use a closed system cath which are pretty pricey. If anyone has first hand info on the coverage I would appreciate it. I have already checked out the website but it is not specific on the DME coverage. Thanks.
    Ride It Like You Stole It!

  • #2
    Might want to call UTI. I don't use closed caths but they bill FedBlue and accept their payment as full. I don't pay a dime.
    "Never argue with an idiot; they'll drag you down to their level and other people may not be able to tell the difference."

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    • #3
      Many insurances use the Medicare criteria for payment for closed system intermittent catheters. You will most likely need a letter of justification for this from your physician. Here are the criteria:

      IC using a sterile (closed system, cath tray, etc.) intermittent catheter is covered when the user meets one of the following criteria:
      1) Residents of a nursing facility.
      2) Immuno-suppressed patients such as those with AIDS or on cancer chemotherapy.
      3) Documented vesico-ureteral reflux.
      4) Pregnant, spinal cord injured patients.
      5) Patients with two or more documented UTI/year.

      The UTIs would need to be true, febrile UTIs, not just positive urine cultures (colonization).

      (KLD)
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      • #4
        Thanks. That is what I had to do originally when I had to get coverage through the Anthem plan that I have now and they have covered ever since. I would assume it should be rather easy with a new plan especially if I select BCBS which is the same company.
        Ride It Like You Stole It!

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        • #5
          Phrased differently, I have Fed BC/BS and get my supplies from UTI Medical. They accept the payment from Fed BC/BS and it doesn't cost me any additional out of pocket expenses. The down side to Fed BC/BS will be dealing with CareCentrix for DME which has been nothing but nightmare.
          "Never argue with an idiot; they'll drag you down to their level and other people may not be able to tell the difference."

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          • #6
            Thanks Quad. The caths are the biggest factor for me because monthly they run about $850.
            Ride It Like You Stole It!

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            • #7
              I am a federal employee and I have the family blue cross and blue shield code 105. I get my catheters from Summit Medical Supply out of New York. I don't pay a penny for my catheters after I have met my $250.00 yearly out of pocket deductible as the company takes whatever BC&BS pay as payment in full. Just Google Summit Medical Supply and check them out. They run the claim through the state of New York BC&BS and call you every month to see if your ready for your next order. I get 200 catheters a month from them. I have had nothing but great luck with them and would recommend them to anyone looking for a new medical supplier

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              • #8
                Thanks!
                Ride It Like You Stole It!

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