What is the difference between Coverage and Payment (also known as Reimbursement)?
The term “coverage” refers to the decision insurance companies make regarding whether a patient will have access or “coverage” to therapy like the Cala TAPS therapy. If a “coverage” policy exists within that insurance company, they would rely on that “coverage” policy and approve the requested therapy according to the rules/stipulations specified in that policy. If no coverage policy exists for Cala Trio therapy, then the coverage would be determined (approved or not approved) on a case-by-case basis.
The term “payment” refers to the amount the insurance company would provide for the Cala TAPS therapy and supplies, and/or reimbursement/payment to the healthcare provider for professional services. If the Cala TAPS therapy is a covered benefit by the patient’s insurance provider, a patient copay or deductible may be required based on the benefit plan.