Medicare benefits may be used for Cala Trio therapy; however, payment and out-of-pocket copay costs are based on the type of plan chosen by the patient. Cala does not make any guarantees regarding claims approval.
The 60-day return policy does not apply to Medicare or other government program patients. Medicare requires all fees to be paid for each month of Cala Trio use. Upon termination of use and return of the product, the patient will no longer be charged their out-of-pocket fees, and Cala will stop billing Medicare.
Because Cala Trio therapy is durable medical equipment, Medicare has designated it to be billed in a capital rental model (cap rental) over 13 months:
Example: Patient uses therapy for three months and returns: Medicare pays 80% of the Medicare fee they’ve set, and the patient is responsible for 20% of that Medicare set price. Costs include 3/13ths of the stimulator and the monthly fee for the band replaced every 90 days. After three months, Cala stops billing Medicare on behalf of the patient.
Medicare claims are being submitted with medical necessity documentation from your prescribing healthcare professional. Each claim is reviewed on a case-by-case basis and may require appeals.
Cala Customer Care processes Medicare Advantage (Part C) claims because we are an accredited provider with Aetna, Blue Cross Blue Shield, and United Healthcare. Based on our experience with these payers and plans, a prior authorization request may be needed for patients using Medicare Advantage plans. Cala Customer Care can assist with the appropriate documentation.
MKG-1533 Rev C Oct 2022