Beginning October 1, 2022, patients enrolled in Medicare will have expanded access to Cala Trio therapy. Cala is submitting claims on behalf of patients to Medicare for individual approval. In addition, Cala can provide increased visibility to patients about their out-of-pocket costs for therapy based on their benefit plans.
- Cala Trio therapy requires a prescription from your doctor.
- Your doctor needs to submit the prescription with notes from your chart to justify medical necessity. You can help your doctor by bringing documents that will generate the chart notes by completing these forms.
- Your doctor faxes the prescription, supporting medical necessity documents, and a copy of your insurance card to Cala, who will submit the claim to Medicare on your behalf.
- The Cala Patient Intake and Agreement form can be signed and submitted with your prescription.
- After your doctor provides the prescription and supporting documents, Cala will validate the information for completeness and, if required, gather any additional notes.
- Cala will call to provide you with your out-of-pocket costs and confirm we have a signed Patient Intake and Agreement.
- Cala ships you Cala Trio therapy.
- Cala submits the claim to Medicare on your behalf.
- Medicare responds with an approval or denial.
- If Medicare denies the claim, Cala will appeal up to three times on your behalf.
- When Medicare approves your claim, Cala will contact you to collect your copay.
- If you are enrolled in Original Medicare (Part B), your copay is collected monthly, and you will be charged for each month you keep the device. Cala will continue to bill you monthly for as long as you use therapy.
- If you are enrolled in Medicare Advantage (Part C), your copay (amount and term) is determined by your selected plan. Cala will assist you in understanding the specifics of your plan’s copay amount.
- If Medicare does not approve your claim even after appeals, you have two options:
- You can return the product, and we won’t charge you, or
- You can keep the product and pay the full Medicare price.
Medicare will pay 80% of the stimulator and band costs; you are responsible for the remaining costs (20%) after your annual deductible is met.
- For Original Medicare: Payments for the stimulator are spread over 13 months, and the band is billed monthly. Your copay may be less than 20% based on supplemental plans you are enrolled in (e.g., Medigap).
- For Medicare Advantage: Payments for the stimulator and band are billed per the individual Medicare Advantage plan that you participate in. Cala will assist you in understanding the specifics of your plan’s copay amount and payment terms.
If you and your physician decide not to continue with Cala Trio therapy, there are options.
- For Original Medicare: The device can be returned anytime. Under Medicare rules, patients must pay their copay monthly as they use therapy. Cala will collect the monthly copay fees based on ongoing Cala Trio therapy use. Upon termination of therapy use and return of the product, you will no longer be charged copay fees, and Cala will stop billing Medicare. You are only financially responsible for the months you have used Cala Trio therapy.
- For Medicare Advantage: Cala provides an estimated copay before shipment and bills you when your carrier issues an explanation of benefits confirming the amount. If you decide not to continue with therapy, you must advise Cala immediately and return the device.
How does expanding Medicare patients' access impact those receiving care at the VA or with Commercial Insurance?
Medicare rulings, policies, and procedures do not impact these other benefit plans.
MKG-1533 Rev C Oct 2022