No Cost Eligibility

Depending on your insurance coverage policies ExEm® Foam could be fully covered under your insurance plan. Should your insurance provide this coverage, that may mean you will have no copay, deductible or out-of-pocket costs.*

*Verify with your insurance provider to confirm coverage under your specific individual plan. Fees for ExEm® Foam (and/or the HyFoSy procedure) may apply.

How to Check Your Health Insurance Coverage for ExEm^® Foam

1. Call the customer service number located on your insurance card.
2. Inform the customer service representative that ExEm® Foam is administered through your provider using the HyFoSy procedure for tubal patency testing.
3. Ask them to check if ExEm® Foam is covered under the Affordable Care Act.
4. Provide them with the J code: J3490
5. Ask if ExEm® Foam is fully covered and the terms and conditions of coverage, or if you will have any out-of-pocket or copay costs.
6. If ExEm® Foam is not covered under your medical benefit, then it may be covered as a pharmacy benefit. You may call the customer service number on the back of your prescription card to check if ExEm® Foam is covered under your pharmacy benefit.

Self-Pay

If you don’t have insurance, or if your insurance doesn’t cover ExEm® Foam, you may self-pay through the pharmacy. Contact us, or have your provider contact us, for pharmacy information at 1.888.963.EXEM (3936).