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High output ostomy covered by a State Medicaid insurance (A4413).

Wed Sep 01, 2021 12:30 am

coloplast sensura mio 2 piece High-output/

Hi,

I'm new to this group. I have short bowel syndrome with a crazy high output jejuostomy! So, after sampling these from Coloplast, I have discovered a solution to my very high output jejuostomy (I had my whole ileum and colon removed along with half of my jejunum in February 2021).


My ostomy outputs 6-8L per day. I used this for day wear and combined this with coloplast nighttime draining bags for night wear, and this solved 99.999% of al my leak and bursting bag issues. 

Im desperately trying to find a supplier who works directly with state Medicaid insurance in order to get these pouches and barriers covered (in a monthly qty of each, since I can only get one pouch use per barrier, and I eat time of 2-3 days). I was having very frequent leaks and bursting bags issues (especially overnight) despite using the nighttime draining bags if the stool did not move from my stoma down the tube). 

they would have to cover ostomy supplies with the insurance code A4413 I was told. I tried calling 9 different suppliers today as I found this out last minute for my sept order, and only have one sample left. If anyone at all can help (has been in this situation and managed to find a supplier who covered their high output bags - even if PA required- can post their supplier?).

In fact, it can't hurt if everyone with short bowel OR a high output Osotmy of any kind could please comment with their supplier? I'm willing to call MANY suppliers to find one that can help me since for me, these bags are medically necessary for sure. It's a constant terror to always be afraid your output will bust your bag especially in public or when you don't have any way to prevent this. 

any and all help is greatly appreciated!! Thanks!!!

These are the top 5 issues ostomates face:

1. Dating and relationships
2. Concealing the pouch
3. Foods to eat and avoid
4. Losing or gaining weight
5. Pouch ballooning

Check out this video from MeetAnOstoMate.
Wed Sep 01, 2021 2:10 am

Hello Jeju.

Thank you for sharing your problem and, although I have no direct experience of these specific things I feel sure that there are others on this site who will chip-in with some suggestions. 

What I would say is that here in the UK we have a National Health Service ( NHS) where the sort of problem you describe does not often arise, as those items that are necessary are free of charge to the patient. 

Of course, the 'NHS' solution is a 'political one and has been politically 'fought' for over many years. However, what I have found is that politicians (& the media) can sometimes be quite helpful with regard to specific cases that become difficult to resolve through the various organisations and systems that act as blocks to progress. 

When vulnerable people ask questions, quite often they are not heard or they are ignored. However, when prominent people like politicians (or other celebrities) ask the same questions, then people seem to take more notice. When the questions are embarrassing for those who are being obstructive, it can often be remarkable how quickly the problems are resolved by those who are most likely to recieve the negative publicity. 

I share this with you from a position of experience in successfully utilising this technique on behalf of 'the deserving patients'.

PS: I have also found that an appropraite accompanying rhyme can be a very powerful persuader!

Best wishes

Bill  

Wed Sep 01, 2021 9:21 am

 

  Bill wrote:  

Hello Jeju.

Thank you for sharing your problem and, although I have no direct experience of these specific things I feel sure that there are others on this site who will chip-in with some suggestions. 

What I would say is that here in the UK we have a National Health Service ( NHS) where the sort of problem you describe does not often arise, as those items that are necessary are free of charge to the patient. 

Of course, the 'NHS' solution is a 'political one and has been politically 'fought' for over many years. However, what I have found is that politicians (& the media) can sometimes be quite helpful with regard to specific cases that become difficult to resolve through the various organisations and systems that act as blocks to progress. 

When vulnerable people ask questions, quite often they are not heard or they are ignored. However, when prominent people like politicians (or other celebrities) ask the same questions, then people seem to take more notice. When the questions are embarrassing for those who are being obstructive, it can often be remarkable how quickly the problems are resolved by those who are most likely to recieve the negative publicity. 

I share this with you from a position of experience in successfully utilising this technique on behalf of 'the deserving patients'.

PS: I have also found that an appropraite accompanying rhyme can be a very powerful persuader!

Best wishes

Bill  

 



Thanks Bill, I sure have heard of the NHS, I am fascinated with UK music and culture. I also use Coloplast which they told me they're the most popular brand in the UK too. I should have listened to my friend and moved there to be with him. Lol, I didn't have an ostomy at that point but he always said how much the NHS would take care of me if I moved and applied for citizenship. (I need this high output coloplast bags so bad, I pretty much would move to get a better quality of life!!!) thanks for answering and hopefully I'll enjoy being an osotomate on here.

I guess this question is for usa ostomates, with a high output osotmy and or short bowel syndrome as well. I'll be calling more suppliers today - wish me luck!!

 

cheers x

 

Mon Sep 06, 2021 4:56 pm

Hi Je-ju! 

I'm not understanding why the suppliers are not filling your supply order. Do you have a prescription from your doctor or WOC nurse? Does the suppliers accept Medicaid?

As long as they get paid I don't know why the suppliers give a care how many you use.

Make sure you're talking to the right people and are asking the right questions.

Good luck!

Jo

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