Reimbursement Guidance


Thank you for your considering the Coapt Complete Control System Gen2 pattern recognition platform for your patients. We commend you as an innovative clinician who embraces technological advances for the benefit of your clients. As a company dedicated to providing advanced solutions to individuals with upper-extremity limb loss and congenital differences. We are confident the Gen2 Coapt Complete Control System is the best choice to improve control and function for your patient.

Coapt is committed to our partnership with you. We are there to provide you with information and guidance as you go through the reimbursement process. You are not alone in the process. We are on your side to help provide your patients with the best in prosthetic control.

From helping partner clinics just like yours navigate reimbursement for Coapt technology, we’ve learned a thing or two and can help guide you through successful preparation, submission, appeals, and authorization. The key is getting involved with us from the beginning—we’d love to help you avoid common pitfalls and omissions from the start.

Our comprehensive reimbursement guide contains information to guide you as you compile and submit a complete and compelling reimbursement justification. Our package provides you with information on the necessary steps to facilitate the reimbursement process, academic references, and other helpful information to increase your chances of receiving successful authorization. While we strive to provide you with the most up-to-date information and tips to support your reimbursement claim, please remember this package contains sample text only, and use of this guide does not guarantee reimbursement.

4 TIPS FOR COAPT REIMBURSEMENT SUCCESS

1. Understand your client’s insurance benefits.


Get ahead of the game by understanding the medical insurance policy of the payor for your patient from the get-go. Look for opportunities within the services and benefits to which the patient is entitled in the policy in order to gain an advantage early on and understand if there are policy exclusions.

Leverage your resources as you navigate the stormy waters of health insurance policies. Determine what materials will help your individual case.

Know that it’s nearly impossible for any clinician to know every nuance of insurance policy, so that’s when to lean on your partners, like Coapt, in this process.

2. Document in advance; anticipate a denial.


Do not be discouraged when your comprehensive pre-authorization submission is denied. Start promptly on your appeal and consult with the experts to craft it.

Careful planning can help you prepare for that first denial. Make sure that you:

  • Document thoroughly your patient’s need and eligibility for this device, including supporting medical records, detailed physician prescriptions, and related documentation;
  • Obtain a letter of medical necessity;
  • Gather supporting product detail from the manufacturer(s);
  • Calculate an accurate estimate for the device; and,
  • Check your work with the manufacturer(s) before you submit it.

Remember that Coapt offers and encourages pre-submission review services to ensure your ducks are in a row before you start pre-authorization communications with the insurer.

3. Seek specific guidance from reimbursement specialists.


If you find yourself stuck at any part of the process, a Coapt reimbursement specialist can help guide you to the next step, because they’ve been successful with each of those steps before. They can assure you that someone has faced a similar obstacle and advise how to overcome, according to your individual needs. They can even advise on specific language to use based on peer-reviewed facts about the device and its FDA clearances, for example.

The specialist will ensure you’re equipped to “fight the good fight” for your patient. They understand the importance of really knowing your patient’s story, and how the Coapt technology can positively affect their life. That very information can be an important piece in making the difference to a payor in authorizing a claim.

4. Commit and be tenacious. It’s worth it.


The fact is, your patients deserve to use the best tools available to help them navigate their lives. The current environment requires that we advocate for our patients to justify this life-changing Coapt technology where applicable.

It’s important to be honest with yourself and with your patient that this isn’t a quick fix. Successful reimbursement is a journey that we take together, and it can take many months. There will be setbacks, but you can help power through them. Giving up—or not starting out—can mean your patient doesn’t have access to the technology that will best fit them; or, if they do get that device, they’ll pay much more out of pocket for it.

We can help

Get in touch with our Reimbursement Guidance team and access our resources today.

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