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NATIONAL SURVEY AMONG CATHETER USERS: EXAMINING CATHETER USAGE AND COVERAGE BY HEALTH PLAN
Maryellen S. Kelly, DNP, CPNP, MHSc1, Dawne Widener-Burrows, MA2, Judy Thibadeau, MN, RN3, Sara Struwe, MPA3.
1Duke University, Durham, NC, USA, 2Widener-Burrows Inc, Annapolis, MD, USA, 3Spina Bifida Association, Arlington, VA, USA.

BACKGROUND: Approximately 70% of individuals with a neurogenic bladder utilize urinary catheters on a regular basis. Inconsistencies exist between healthcare insurers and plans regarding coverage of urinary catheters and their supplies (i.e. gloves, lubricant). The Spina Bifida Association, Christopher & Dana Reeve Foundation, United Spina Association, Paralyzed Veterans of America, and our university partnered to survey a large group of individuals who use urinary catheters regularly to better understand to what extent catheters are being covered by health insurers and to ascertain what users' out-of-pocket costs are for catheters and their supplies. Also, an inquiry into the success of using an insurance appeal for overage was done.
METHODS: Survey content was generated by members of the above organizations and was programmed into Qualtrics. Branching logic was utilized with the maximum number of questions an individual would be asked at 29 and an expected completion time of 10 minutes. The survey was translated and administered in Spanish and English. The survey was distributed via each non-profit's registered email list and social media. The survey was open from 1/19/21-2/15/21 and only included individuals who used catheters themselves or were the primary caretaker of an adult or child who uses catheters regularly. To assess, the association between insurance groups and out-of-pocket costs we used two-sample t-tests were used to compare means, and Mann-Whitney U tests were used to test the equality of between-group medians. Kruskal Wallace test was used to assess differences between groups of catheter users in data that did not meet normality assumptions. Results were deemed statistically significant when the p-value was <0.005.
RESULTS: 2366 individuals who responded met inclusion criteria. Straight catheters were the most used catheter representing 63% of respondents as users. The average number of catheters used per month for all types of catheters besides Foley and Condom Catheters was 136/month. 36% reported only having a public/government health plan and 25% reported only having an employer-provided commercial plan, the remainder had both. Of those with public/government insurance, 8% reported that their health plan did not cover any costs for their catheters. For those with commercial coverage, 17% reported their plan did not cover any costs. 42% of those with United Health Care (13% of all who were commercially covered) reported their plan did not cover any costs. Out-of-pocket costs varied significantly amongst insurance plans. Mean annual out-of-pocket costs for catheters and supplies were $1,464 for those who pay anything after their deductible is met. Appeals to insurance companies for coverage were denied 30% of the time with 61% of these denials stemming from one insurance company.
CONCLUSIONS:
Catheter users are covered by a variety of health plans with the greatest proportion covered by public/government plans which also cover the largest percentage of catheter and supply costs. Large variations in coverage and out-of-pocket expenses exist for users dependent on the health plan.


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