Patients
How do I qualify for biologic wound care?
If you're considering biologic graft or wound covering placement for a chronic wound, understanding Medicare and secondary insurance approval is essential. Medicare typically covers biologic grafts for non-healing, chronic wounds, such as diabetic ulcers or pressure ulcers, that have not responded to traditional treatments.
- Coverage is generally available when the wound has persisted for at least 30 days despite standard therapies like dressings or debridement.
- The graft must be FDA-approved, and your healthcare provider must document that it is medically necessary.
- To ensure approval, all prior treatments, wound assessments, and reasons for the failure of conventional methods need to be clearly documented.
Secondary Insurance
For patients with secondary insurance, it's important to check if your plan has additional requirements beyond Medicare. Many secondary insurers will follow Medicare's criteria, but they may have specific policies regarding the types of biologic products covered or the number of applications allowed.
- Having both Medicare and secondary insurance can increase the likelihood of full coverage, but ensuring that your provider submits all required documentation and medical justification is key to avoiding out-of-pocket costs.
- Make sure to consult with your healthcare provider and insurance company to confirm your benefits and streamline the approval process.
Experienced Healthcare Professionals
At Mobile Wound Rx, our team of experienced healthcare professionals will guide you through the entire process, starting with a comprehensive evaluation of your wound and medical history.
- We work closely with your physician to assess the best treatment plan, including determining whether biologic graft or wound covering placement is the right option for your condition.
- Once the medical necessity is established, our team will handle all aspects of obtaining insurance approvals, including verifying your coverage with Medicare and any secondary insurance providers.
- We ensure that all documentation is submitted correctly to streamline the approval process, so you can focus on healing while we take care of the logistics.
