How to Get Diapers, Pull-Ups & Incontinence Supplies Covered by Insurance in New Jersey

Possibly. If your child or dependent needs diapers, pull-ups, briefs or other incontinence supplies because of a medical condition or disability, insurance may cover some or all of the supplies. NJ FamilyCare covers medical supplies and durable medical equipment when applicable, but coverage depends on medical need and the requirements of the person's specific health plan.

Tell the pediatrician, primary care doctor or appropriate treating provider that your child continues to need incontinence supplies. Ask whether they can provide the prescription or order and the medical documentation required by the insurance plan.

• The child's diagnosis or medical condition
• Why the supplies are medically necessary
• The type of supplies needed
• The correct size
• The approximate quantity and frequency needed
• The expected length of need

Call the Member Services number on the back of the insurance card.

• Are incontinence supplies covered?
• Is there an age requirement?
• Is prior authorization required?
• What documentation or prescription is required?
• Are there monthly quantity limits?
• Which medical supply companies participate in my plan?
• Does the supplier handle the authorization with the doctor?
• Can supplies be delivered to our home?

Do not assume you can buy diapers at a regular store and submit the receipt for reimbursement. Many insurance plans require families to obtain supplies through an approved or participating medical supply company.

Ask your insurance company for the names and contact information of participating suppliers that provide incontinence products. The supplier may then contact the doctor's office directly for the prescription and other required documentation.

Depending on the plan, the medical supplier, doctor's office or both may need to send documents to the insurance company.

• What products are covered?
• What brands are available?
• How many items can be received each month?
• Can we choose diapers, pull-ups, briefs or another product?
• How frequently will supplies be delivered?
• Do we need to confirm the order every month?
• What should we do if the child's size or needs change?

If your child has NJ FamilyCare, start with the health plan shown on the insurance card. The current managed care plans and Member Services numbers listed by New Jersey are:

• Aetna Better Health of New Jersey — 1-855-232-3596
• Fidelis Care — 1-888-453-2534
• Horizon NJ Health — 1-800-682-9090
• UnitedHealthcare Community Plan — 1-800-941-4647
• Wellpoint (formerly Amerigroup New Jersey) — 1-833-731-2147

• Why was the request denied?
• Was information missing from the doctor's documentation?
• Can the doctor submit additional medical-necessity information?
• Can the decision be appealed?
• What is the deadline to appeal?
• Can the plan send the denial and appeal instructions in writing?

Keep copies of prescriptions or orders, medical-necessity documentation, authorization requests, denial letters, appeal documents and reference numbers from insurance calls.

Diaper banks and community organizations may also be able to help. New Jersey's Essential Items for Children page lists assistance, and families can call NJ 211 to ask about local diaper banks.

Some diaper banks require a referral from a social worker, case manager, WIC, SNAP or another participating organization. Ask what is required before visiting.

• What exact document does the plan need from the doctor?
• Which participating suppliers carry the right size and product type?
• Who will submit the prior-authorization request?
• How will the family learn whether the request was approved?
• Who should the family call if an order is late, incorrect or no longer fits?

• A prescription or order does not guarantee that the plan will approve a specific product or quantity.
• Do not assume a retail purchase will be reimbursed; ask the plan before buying supplies.
• Age rules, quantity limits, documentation and participating suppliers can differ by plan.
• Never send a member ID, Social Security number or medical records through an unsecured website form.

• Call the Member Services number on the insurance card and ask what documentation and participating supplier your child's plan requires.

• NJ FamilyCare and Medicaid: How Coverage Connects to Services
• Find ResourcesBrowse New Jersey programs, community resources and government resources.

• NJ FamilyCare health plans Official New Jersey list of managed care plans, Member Services contacts and member materials.
• NJ FamilyCare Official program information, applications and member resources.
• Essential Items for Children Official New Jersey resource page for diapers, wipes, clothing and other essential items.
• NJ 211 Call 211 or search for local community assistance, including diaper banks.