Posted on Mar 13, 2015 3:30:00 PM by Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD

Insurance Coverage for PTNS

Avoiding Coverage Surprises on Patient Invoices

Discussing Insurance CoverageAll of us have had challenges with insurance covering medications and treatments. Pre-authorizations seem to be an “activity of daily living” in clinic offices. Some days it appears to be quite overwhelming and redundant. So, how can you make the process easier?

In our clinic we pre-authorize everyPTNS series of treatments even though we know the treatment is covered by certain insurances. Surprises on a patient invoice are never the sign of a good day! What has helped us are the following:
  • Know your insurance company, the forms they use, the process they require and the time it will take to get an answer.
  • Have necessary information available.  

Streamlining Pre-authorization

We all know that PTNS is NOT first-line therapy for OAB. Help your staff out by having a flow sheet in the medical record of all previous treatments for OAB. Note what they were, the dates and why they failed. If you have EMR, it might be helpful to have this added to your documentation. This form is the most helpful piece we have when it comes to pre-authorization. It is all right there. It makes it especially easy if office personnel who are not health care professionals are doing the pre-authorizations. Time is money!

If you would like a copy of the form we use in our clinic, please email me at wooldrle@trinity-health.org.

I would be happy to email you a copy. Since I am a nurse practitioner, it also has a spot for my collaborating physician to sign so there is always a physician order for PTNS on the chart.  

Documenting Past Therapy

Also keep in mind that many OAB patients may not progress to PTNS therapy. Many are better just with behavioral changes. More get better by adding medications that are well tolerated. This documentation keeps a trail of what you have done, when and what the results were. It beats reading a chart of events over the past several years and figuring out why you switched from one treatment to another.  

Try it. You might like it!

Urgent PC is the Proven PTNS

This blog post reflects the opinions and experience of Leslie Wooldridge, a long-standing user of the Urgent PC Neuromodulation System, and was produced under a paid consulting agreement with Cogentix Medical.

Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at www.cogentixmedical.com. Models are for illustrative purposes only. Urgent is a registered trademark of Cogentix Medical © 2015 Cogentix Medical. All rights reserved. 
Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD
Leslie Saltzstein Wooldridge, GNP-BC, CUNP, BCIA-PMD, is Director of the Adult Bladder Control Center, Mercy Health Partners, Muskegon, Michigan USA. Ms. Wooldridge received a Master of Science degree in nursing administration, critical care nursing and postgraduate certification as a Geriatric Nurse Practitioner from Marquette University, Milwaukee, Wisconsin. In 2015, she was honored with the Women’s Health Foundation Activist Award. She is also the recipient of the 2009 National Association for Continence Rodney J. Appell Continence Champion Award. Ms. Wooldridge has published in multiple refereed journals. She authored the Genitourinary chapter in The Nurse Practitioner in Long Term Care: Guidelines for Clinical Practice (2007). She has lectured throughout the United States on geriatrics, urology and clinical practice.
Return To Blog