Reimbursement for Peristeen Plus varies depending on your healthcare plan coverage.* It is important to check your individual insurance benefits for Peristeen Plus coverage directly with your plan administrator.
Once your clinician prescribes Peristeen Plus, our Coloplast® Care Advisors can help identify supplier options that work with your insurance. The assigned supplier will then obtain any necessary documentation for the prior authorization from your clinician, and will work on the prior authorization process with your healthcare plan.
Important notes on reimbursement:
- Some insurances require prior authorization for Peristeen Plus
- To secure a prior authorization, your supplier will need a valid prescription, medical records that meet the medical necessity requirement of your insurance (if applicable) or, if required, letters of medical necessity
- If your prior authorization is denied, you or your physician may be able to appeal the denial. This process is typically outlined on your denied authorization or explanation of benefits (EOB).
- If your insurance states that Peristeen Plus is considered an exclusion to your health plan benefits, check your benefit details to confirm if this is accurate. If so, you can work with your employer's HR department to request a “rider” be attached to your health plan benefits for coverage.
- If your insurance plan does not cover Peristeen Plus, there are out-of-pocket purchase options available with selected suppliers.
*Reimbursement Disclaimer: Coloplast Corp. provides this information for your general reference and related to the reimbursement of Coloplast products only. Reimbursement, coverage and payment policies can vary from one insurer and region to another and may change over time. Coloplast does not guarantee coverage or payment of products. This information is provided for your general information only and is not intended to replace any advice you receive from your own internal or external insurance coverage consultants.
Information from Coloplast® Care is for educational purposes only. It is not intended to substitute for professional medical advice and should not be interpreted to contain treatment recommendations. You should rely on the healthcare professional who knows your individual history for personal medical advice and diagnosis. Prior to use refer to product labeling for complete product instructions for use, contraindications, warnings and precautions.
Indication: The Peristeen® Plus Transanal Irrigation System is intended to instill water into the colon through a rectal catheter, which incorporates an inflatable balloon, inserted into the rectum to promote evacuation of the contents of the lower colon. The Peristeen Plus Transanal Irrigation System is indicated for use by children (2 years - <12 years old), adolescent (12 years - < 18 years old), transitional adolescent (18 - <21 years old) and adult patients with neurogenic bowel dysfunction who suffer from fecal incontinence, chronic constipation, and/or time-consuming bowel management procedures.
Contraindications: Peristeen Plus Transanal Irrigation must not be used in the following situations: known anal or colorectal stenosis, colorectal cancer (active/recurrent), radiotherapy to the pelvis, and recent abdomino-perineal surgery, active inflammatory bowel disease, acute diverticulitis, severe diverticulitis, previous diverticulitis and diverticular abscess, chronic symptomatic diverticular disease, within 3 months of abdominal, anal or colorectal surgery, within 4 weeks of endoscopic polypectomy, recent colonic biopsy, recent endoscopic mucosal resection (EMR) and recent endoscopic sub-mucosal dissection (ESD), severe autonomic dysreflexia, ischemic colitis, during Spinal Cord Shock Phase, complex diverticular disease, in patients who are pregnant and have not used the system before*. Since the list is not exhaustive, the healthcare professional should always consider individual patient factors as well. *If the patient is pregnant and has never used transanal irrigation before, they should not start the irrigation procedure during pregnancy.
Warnings: Peristeen Plus Transanal irrigation procedure should always be carried out with caution. Bowel perforation is an extremely rare, but serious and potentially lethal, complication to transanal irrigation and will require immediate admission to a hospital, often requiring surgery. See the device manual for complete user instructions, contraindications, warnings, precautions, and potential complications/adverse events. For further information, call Coloplast Corp at 1-855-605-7594 or consult the company website at www.coloplast.us. Caution: Federal law restricts this device to sale by or on the order of a physician.
