|w30bob wrote: |
You're mostly right............but most insurance companies do have a limit as to how many ostomy supplies they'll pay for in a 30 day or 90 day supply. Of course you're always free to buy your own "out of pocket". When I was changing my barrier every day (due to skin issues) my insurance (and I have great Federal Government health insurance) would only pay for 30 barriers per month. I was asking for something like 45 in case I had to change more than once a day or screwed one up when installing. Other insurance companies have different limits. It's spelled out in the fine print of your policy somewhere. But I've never had an issue with me picking the brand of products, or different specific products (barriers, bags, belts, rings, paste, etc).......as you said, that's between you and your Doc. And every Doc I've ever seen to write such a prescription never even questioned why I wanted a specific brand........they always seemed to want to just write the darn script and get it over with ASAP. Now when I do call to re-order my supplies.........I can change a quantity down without them needing the Doc's permission, but if I want to change it up........they'll need my Doc to approve. Which has never been a problem either. It's always a bit funny when I see my Primary Care Doc to get a new script for ostomy supplies. I hand her my list of products and quantities, and without even looking at it she hands it to her assistant and says "Get Cowboy Bob a script for these immediately". I could stick "Oxycodone 80mg tabs, qty 200" in my list between barriers and bags and no one would be the wiser! I think the last thing a Doc wants to do is challenge an ostomy patient on what supplies they need. Just sayin'.
Bob, thanks for the explanation. But I am still shaking my head. The very fact that insurance companies have limits on the amount of products you can buy, and that you need to get your doctor to approve an increase is just wrong. As you said, you could put anything on the form your doctor has to sign, so isn't that a waste of her time? She is signing based on what you tell her you need, therefore YOU are determining your needs, as it should be. Your insurance company makes you jump through an extra hoop just because they can. It's one thing to get a doctors signature on a form requesting medications - OK, fine, I get that. But ostomy supplies? Seriously? Can you OD on those?
I have no limits on what products or how much I buy - my private insurance will pay for it, no questions or doctor approval required. By the way, my private insurance, which is optional, costs just under $260 per month for family coverage. It even covers my 30 year old son, because he is still a full time student. It covers all prescription drugs, glasses, ostomy supplies, physiotherapist, massage therapy, hearing aids, assistive devices (walkers, canes, etc) psychologist or social worker counselling, orthotics, access to Cancer CarePath (a cancer navigation agency that saved my sanity), and out of country travel insurance. We could choose dental coverage as an option, but since we all have good teeth, decided to pay out of pocket for dental, although we can opt in anytime. And, as I said, my healthcare (doctor visits or hospitalization) is entirely free.
While I think our system is good, it is not as good as the British National Health Service. I think it's helpful, especially in an election year, to look around the world and see what exists outside one's own borders. Knowing what the standards are in the rest of the world can help define what your standards at home could be.