Healix360 Wound Care Insurance & Billing in 2025

Understanding Your Coverage for Advanced Wound Care

We accept Medicare Part B and most major insurance plans. Learn how your coverage works for regenerative wound care treatments.

Medicare Part B (Original Medicare)

Best Coverage for Advanced Wound Care

If you have Original Medicare Part B (the standard Medicare plan), you have excellent coverage for our advanced regenerative wound care treatments. Medicare Part B covers medically necessary wound care services, including:

Why Medicare Part B Works Best

Medicare Part B provides comprehensive coverage for advanced wound care treatments without the restrictions often found in Medicare Advantage plans. Most of our patients with Original Medicare Part B experience smooth approval and coverage for their treatments.

Medicare Advantage Plans

Medicare Advantage (also called Medicare Part C or “MA Plans”) are offered by private insurance companies approved by Medicare. While these plans can offer additional benefits, they often have different coverage rules and restrictions for advanced wound care treatments.

Quick Links to Healix360 Wound Care, Insurance & Resources

Common Medicare Advantage Coverage Challenges:

Prior Authorization Requirements

Many Advantage plans require approval before treatment, which can delay care

Limited Provider Networks

You may need to use specific providers or get referrals

Treatment Denials

Some advanced regenerative therapies may not be covered by your specific plan

Variable Coverage

Coverage differs significantly between Advantage plan carriers and specific plans

We Can Help

If you have a Medicare Advantage plan, we’ll work with you to verify coverage and pursue authorization. However, please be aware that some treatments may not be approved. We recommend contacting your plan directly to understand your wound care benefits before your first visit.

Medicare Supplements & Secondary Insurance

Medicare Part B + Medigap

This combination typically provides the best coverage for advanced wound care. Medigap helps pay the 20% coinsurance after Medicare Part B covers 80%.

Excellent Coverage

Other Supplemental Plans

Some supplemental insurance plans have restrictions on what they cover, especially for advanced or regenerative treatments. Coverage varies by carrier and policy.

Verify Coverage

What About My Supplemental Plan?

If you have a supplemental insurance plan (not Medigap) or secondary insurance, coverage for advanced wound care treatments can vary significantly. Some plans may:

Have different approval requirements than Medicare

Not cover certain regenerative or advanced therapies

Require you to meet specific medical criteria before approval

Deny coverage even when Medicare Part B approves

Private Insurance

We work with most major private insurance carriers. Coverage for wound care varies by plan, so we recommend verifying your benefits before treatment.

We'll verify your insurance benefits
We handle prior authorizations
We bill your insurance directly

Medicaid

We accept select Medicaid plans. Coverage varies significantly by state and specific Medicaid program. Please contact us to verify if we accept your Medicaid plan.

Note: Medicaid coverage rules differ from Medicare, and some advanced treatments may require special approval.

Veterans & TRICARE

We honor our veterans. If you have VA benefits or TRICARE coverage, we'll work with you to coordinate care and explore coverage options.

Call to discuss your benefits

Self-Pay Options

If you don't have insurance coverage or prefer to pay out-of-pocket, we offer transparent self-pay pricing. Contact us for a cost estimate based on your specific treatment needs.

Payment plans may be available for qualifying patients.

Common Insurance Questions

How do I know if I have Medicare Part B or Medicare Advantage?

You can check your Medicare or insurance card to determine your coverage. Original Medicare Part B is issued directly by Medicare, and your card will say “Medicare” with Part A and/or Part B listed. Medicare Advantage plans are offered by private insurance companies such as UnitedHealthcare, Humana, or Aetna, and your card will display the insurance company’s name and logo. You may also call Medicare at 1-800-MEDICARE to confirm your coverage type.

Will you verify my insurance before my appointment?

Yes. We verify insurance benefits for all new patients prior to the first visit. If there are any coverage concerns or prior authorization requirements, we will contact you in advance. Please make sure to provide your insurance information when scheduling your appointment.

What if my insurance denies coverage for treatment?

If coverage is denied, we work with you to appeal the decision and submit supporting clinical documentation. We can also discuss alternative treatment options or self-pay arrangements if necessary. Our goal is to ensure you receive appropriate care while working within your coverage limits.

Do I need a referral from my doctor?

Medicare Part B: No referral is required. You may schedule directly with us.

Medicare Advantage & Other Plans: Many plans do require a referral. Please review your plan details or contact us for help determining whether a referral is needed.

What is my expected out-of-pocket cost?

Out-of-pocket costs depend on your insurance plan, deductible status, and coinsurance amounts. With Medicare Part B, patients typically pay 20% of the Medicare-approved amount after meeting the annual deductible. We will provide a cost estimate after verifying your benefits. For billing questions, please contact our billing team at 877-545-1300.

Can I switch from Medicare Advantage to Medicare Part B?

Yes, you may switch plans during specific enrollment periods, including the Annual Enrollment Period (October 15 – December 7) and the Medicare Advantage Open Enrollment Period (January 1 – March 31). If you are experiencing coverage limitations with a Medicare Advantage plan, returning to Original Medicare Part B may provide better access to advanced wound care treatments. Contact Medicare at 1-800-MEDICARE to review your options.

Questions About Your Insurance Coverage?

Our billing team is here to help you understand your coverage and answer any questions about insurance or costs.

Our billing specialists are available Monday-Friday, 8:00 AM - 5:00 PM

Healix360 Advanced mobile wound care specialists connecting patients with regenerative healing solutions. Medicare Part B accepted.

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Understanding Medicare Coverage for Wound Care

Medicare coverage for wound care is essential for patients seeking advanced treatments. Understanding the specifics of what is covered under Medicare can help patients make informed decisions about their care options. This includes knowing which services are deemed medically necessary and how to navigate the complexities of coverage.

For instance, Medicare Part B typically covers various wound care services such as comprehensive assessments, specialized therapies, and necessary follow-up care. Patients should familiarize themselves with these details to ensure they receive the treatments they need without unexpected costs.

Exploring Private Insurance Options

Private insurance plans can vary significantly in their coverage of advanced wound care treatments. It is crucial for patients to understand their policy details, including any limitations or exclusions that may apply to regenerative therapies. This knowledge can empower patients to advocate for their care effectively.

For example, some private insurance plans may require prior authorization for specific treatments, while others may have a more straightforward approval process. Patients are encouraged to contact their insurance providers to clarify their coverage and any necessary steps to access the treatments they need.

Frequently Asked Questions About Insurance Coverage

Patients often have common questions regarding their insurance coverage for advanced wound care. Addressing these inquiries can help alleviate concerns and provide clarity on the coverage process. Topics may include understanding deductibles, copayments, and the appeals process for denied claims.

For instance, many patients ask about the difference between in-network and out-of-network providers and how this impacts their out-of-pocket costs. Providing clear answers to these frequently asked questions can enhance patient confidence and satisfaction with their insurance experience.

How to Appeal a Denied Insurance Claim

When an insurance claim for wound care treatments is denied, it can be disheartening for patients. Understanding the appeals process is crucial for those who wish to contest the decision and seek the necessary care. Patients should know their rights and the steps involved in filing an appeal.

Typically, the first step is to review the denial letter for specific reasons and gather supporting documentation from healthcare providers. Patients can then submit a formal appeal to their insurance company, often including additional clinical evidence to substantiate the necessity of the treatment. Knowing this process can empower patients to take action and potentially secure the coverage they need.