Ordering Ostomy Supplies with Insurance: Process and Quantity Limits?

Hello,

So am I supposed to get a "prescription" from the doctor for ostomy supplies, then call the supply place? Or do I call the supply place with my insurance and they order them just like that? Thanks in advance for your help. Also, I have Cigna. Does anyone know how many you usually qualify for (general idea) with insurance a month?

For me, my ostomy nurse sends in the prescription for me. The pharmacy that I get mine from then calls me to confirm my order. I get 20 drainable bags, 20 barrier rings, a pack (50) of remover wipes, a pack (50) of lubricant, a pack of the flange extender things but I only got those once just to have, I don't normally use them, and a thing of stoma powder. If I want something different, I just have my ostomy nurse change my prescription. The pharmacy just ships me my stuff and it takes 4-5 days to get it usually.

Now, if I don't change my order and it gets to be about a month since I've ordered, the pharmacy sends me a text asking if I want to reorder and I simply text back yes or no.

My nurse did the same as Alex before I left the hospital. I use Edgepark and they send new supplies each month (same order). Right now it's at no cost to me since I maxed my deductible and out-of-pocket costs. John

Hi:

I visit my gastro doc once a year just so that he can "re-fill" the Rx for my ostomy supplies. I order my supplies through Adapt (formerly McKesson). They have an "express order" option and I just go on the site whenever I'm running a little low on my supplies - not sure how many I'm allowed each month as I just order them when I need them. Adapt already has all of my insurance info on file so it's pretty easy.

I have always set up and placed my own order. You call the distributor you want, tell them you want to place an order. If you're new, they will ask for your doctor's name and insurance information along with your name, date of birth, and address. Then tell them what you want (I suggest getting everything you might need like paste rings, extenders, etc.). They will send it over to your doctor, and your doctor will sign off for it. Once they get that back, they will fulfill your order and ship.

I say to place everything in your first order so the doctor only has to sign off once... because if you want to add something later, they have to submit that to your doctor to get approval (it's stupid)... then if you don't need something the next month, you can call and take an item off.

So it's not actually like a prescription. We pay full price till we meet the deductible?

Insurance coverage, copays, etc. will vary depending on who you have and what terms your insurance is under. For me, I pay nothing for my supplies unless I want more than what is the normal allotment.

I have Medicare so they pay for almost 90-day supplies at a time. I hooked up with a pharmacy and ostomy nurse early on and they call me when it's time to reorder or I call them. They reach out to the doc for renewing the RX each year. Good luck! But my advice is to find an ostomy nurse and use them for all their wisdom and great advice. They were lifesavers for me. And they've seen and heard it all so don't be shy.

You need to make certain your doctor will assist with these orders.

Then call medical supplier.

Of Note:

Choosing supplies is like rolling dice cause you must try products first.

If you have a prolapsed stoma you need convex wafers.

Brava is the best line I have found.

Just do not short yourself.

Look through catalogs then create your list.

The supplier can be a pest to a doctor so create a list that truly covers all things you will need.

Hydrocolloid tapes and protective sheets are a godsend.

I have not had luck with stoma care nurses.

The Rx will need updating yearly with doctor chart notes.

Be sure and measure your stoma so you know the size of wafers and pouches.

Again accessory items like Hydrocolloid are needed in my opinion.

They are expensive but if you have a difficult appliance application you will need them.

Calamine lotion comes in handy.

Destin with Zinc is useful too...a thin line around the stoma.

Washing the stoma and surrounded skin in Ivory bath soap is also beneficial.

I use baby wipes with my stoma vs toilet tissue. Expensive but helpful.

As you go you will need items like Qtips; cotton pads; baby wipes; gauze pads.

You want a healthy stoma always.

Also you want items that assist in appliance application.

This is why I use the Hydrocolloid tapes.

Applying an appliance should be quick.

Good luck

If you have Medicare, you are entitled to 90 days' supplies.

Get a prescription for "ostomy supplies" from your doctor. Take or send it to your preferred ostomy source along with your insurance ID. They will get your supply and bill insurance.

Good idea to tell them the exact appliance you want, including stoma size.

I order my supplies from Byrum Health and use Hollister barriers and bags, 2-piece. They worked with my insurance company (BCBS) and then placed my order. The first order took a while because of getting approval. Cigna may be faster. Let me know if you have questions about which supplies I have found to be most effective.

Heather

My ostomy nurse set me up originally and monthly. The supply company, mine is Byram Health, calls to remind me to reorder.

Vickie