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Medicare coverage

 
This is the best website for people with an Ostomy. So much understanding.

Hi! Does anyone who's on Medicare use both extender strips ( to secure and support wafer at outer edge) and also a barrier ring (to prevent leaks).I I've been using both for a quite a while, ordering the Medicare allowed limit of both each month. But in August, my supplier suddenly tells me that Medicare won't cover them both simultaneously " because they both serve the same purpose" ( which they don't!). I asked if this was a new rule,  because Medicare had been covering both each month up until that point... and the rep basically called me a liar and said that wasn't true... even though I have my back invoices to prove it. Now, they are making me order them on alternate months from each other... but I'm still only allowed a one month supply of each,  every other month,  so I'm needing to make them last twice as long! Another ostomate in a support group of mine tells me her supplier gets her both items each month and that Medicare still covers them. Why would my supplier lie?...Does anyone here use both and can shed light on this?

Thanks in advance!

 

Well, your supplier is not Medicare. I’d simply call Medicare and ask them. Then, depending on what they say, go back to your supplier with the current rule on it. I’m not on Medicare but my insurance won’t cover remover wipes and remover spray in the same order. Since either a box of wipes or a can of spray lasts me 3 months or so, I simply change up my order when needed. 

MeetAnOstoMate - 28,358 members
 

I have not been told this. But, I am not allowed to order tail closures for the pouch and the pouch at the same time. So, I place two separate orders. Hope this helps.

 

I would change suppliers.  I use Edge Park and am very happy with them.

 

Hi,,    I use edge park as well,   but hav e not had any problems with  getting the supplies  I need..   However,  I d o say I change more often....than  I generally do...(   When I  have problems....it can be 3 or four times a week....   b ut mor often...it's once or twice)..   I  get 3 rolls of 3  inch tape, but I ask for 2 different tapes....   one is better for cold water ( in the summ er)   the other, works well with hot w ater , for showers..     If they are denyinng you something/  or  amoun nt you need, aske Dr. for a  new script..  If it's a medicare issue, call medicare...  There are also s ome things that I was buying on my own, because I didn't think it was a  covered item  (   gauze pads) for cleaning the sking with hot water....   I w as surprised that I received those because I also get cleaning wipes....     If they d o not fill y our covered needs,   consider  the suggestions, or change suppliers, or ask to speak to a supervisor...  Good luck   Marsha

 

I get both and they are both covered by Medicare.  Call back and report that person and ask for a supervisor.   If not apologized to, switch to a friendly company.   Many out there.

 


Redondo wrote:

I have not been told this. But, I am not allowed to order tail closures for the pouch and the pouch at the same time. So, I place two separate orders. Hope this helps.

What supply company do you use? Sometimes, the person you are talking to don’t know what they’re talking about! Hang up and get another person. I use Edgepark and have always ordered both, even different size barriers at the same time. I order my supplies every 3 months right to the day, so I get a full years supply

 

I use both of them but I’m only 2 months into my life as an ostomate.  My nurses have been ordering everything and have said it’s all covered by Medicare.  I don’t know if Medicare varies a bit from state to state, but I’d keep calling and get someone nice and compassionate on the phone.  Or file a grievance.  

 

I had a similar issue. After the surgery during two to three years I had very high output. The doctor had me see an Ostomate nurse, which she knew the insurance would ask for; then she gave me a 'Letter of Necessity' which I emailed to the insurance company. This letter forced the insurance to give me 30 bags a month. I no longer have those issues, very little output now due to my normal diet,  but I could easily get that letter from my Doctor and get those 30 again if I wanted to. I think the insurance asks that you see a specialist, my doctor said the ostomate nurse would suffice. I saw the nurse specialized in ostomies, she was wonderful by the way, I still see her once a year, and she asked two questions about the excess fluid at the time and that was that. The insurance was forced to cover the extra pouches. There are laws and regulations, and this is one of them, if it is a necessity the insurance, including Medicare, will be forced to cover. For example, if I was to tell my doctor now that I am having again excessive fluid and that is causing enormous leaks, everywhere, and causing harm and putting others at risk, example a leak in the bed bad for a partner, I would ask for that letter again, for the 30 bags and this time I would add this time  for good measure the 30 extra barriers. I will go see the nurse again, the specialist the insurance asks to see, and she will again give a nod of approval, and I get my Letter of Necessity. I hope this helps. Not sure if it is the case with your particular situation. 

 

Use Edgepark. They’re great. 

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