Patient Insurance Coverage

Augmenix, Inc., manufacturer of the SpaceOAR® System, is devoted to partnering with healthcare professionals and patients to navigate today’s ever-changing health insurance system. This FAQ contains general resources to help get you get started.

 

Frequently Asked Questions

 

Does Medicare Cover and Reimburse for the SpaceOAR System procedure?

There is no national Medicare coverage policy in place for the SpaceOAR procedure at this time; each local Medicare Administrative Contractor (MAC) makes coverage decisions based upon the FDA-cleared indication, published literature, and review of case-by-case claims to confirm “medical necessity” and overall intended use. Based upon the review of medical necessity, Medicare may consider coverage for SpaceOAR and payment to your provider.

How can I find out if my insurance company will cover the SpaceOAR System procedure?

We recommend a verification of benefits be done with your insurance company several days, if not weeks, in advance of the scheduled SpaceOAR procedure. The verification of benefits is a crucial component to understanding the exact coverage criteria under your plan. Your plan may require a Prior Authorization and/or allow for a Pre-determination. These processes are meant to allow your health insurance company the opportunity to evaluate your treatment plan and specifics of the request to review for medical necessity. Please ask your doctor’s office about your anticipated coverage options.

Is there a financial assistance program available for SpaceOAR?

There is no formal patient financial assistance program available for the SpaceOAR System procedure at this time.

What if my health insurance company has denied coverage for the SpaceOAR procedure?

If your health insurance company has denied coverage for the SpaceOAR procedure, you may want to appeal the denial by following these steps:

  1. Contact your doctor’s office and ask if they will submit an appeal on your behalf.
  2. Contact your insurance company and ask to appeal the decision. They will be able to provide you with next step instructions.

How can I find out if my claim, for SpaceOAR, has been submitted to the insurance company?

To find out if your claim has been submitted to your health insurance company, you can contact your doctor’s office directly or contact your insurance company (using the telephone number on the back of your insurance card). You may need to know what date your procedure was performed. It is often best to have this and your insurance information readily available prior to your call.

Disclaimer: The information above is for informational purposes only and is not intended to provide reimbursement or legal advice, nor does it promise or guarantee coverage, levels of reimbursement, payment, or charge. Similarly, all Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Augmenix, Inc., that these codes will be appropriate or that reimbursement will be made. The fact that a drug, device, procedure, or service is assigned a code and payment rate does not imply coverage, but indicates only how the product, procedure, or service may be paid if covered by the program. The individual Health Insurance, Medicare Administrative Contractors (MACs) and/or State Medicaid program administrations determine whether a drug, device, procedure, or other service meets all program requirements for coverage. Laws, regulations, and policies concerning reimbursement are complex and are updated frequently. Therefore, we strongly recommend you consult with your health insurance organization o review your specific coverage options for your anticipated date of service.