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Aug 06, 2024

Insurance for Ostomy Belts - A Personal Struggle

This topic is about the challenges faced when trying to order Nu-Hope ostomy belts through Medicare and secondary insurance. The person involved recently switched from employer insurance to Original Medicare with Medigap Plan G and Anthem BCBS as secondary coverage. Despite having a prescription for the belts, they encountered difficulties with the supplier, Edgepark, and ended up purchasing the belts out-of-pocket. Here are some helpful insights and advice for navigating similar situations:

1. Terminology is important:
- Medicare Part B may cover "ostomy belts" at 80% if prescribed, but it will deny coverage for "hernia support belts" unless they are considered rigid or semi-rigid braces. Ensure the prescription specifies "ostomy belt" instead of "hernia belt."

2. Consider alternative Durable Medical Equipment (DME) suppliers:
- Some people have successfully received Nu-Hope belts through Byram without issues.
- If Edgepark is uncooperative, try contacting their customer service or consider switching suppliers.

3. Verify information online before making a purchase:
- Although Edgepark's website may indicate that Medicare covers Nu-Hope belts at 100%, fulfillment might not occur as expected.

4. Explore alternative brands or products:
- Hollister 2-inch belts are available, though some users find them uncomfortable.
- CardinalHealth belts can be substitutes when Adapt support belts are unavailable.
- Adapt support belts from Hollister and Stealth Belt products, which include various styles and are praised for activities like hiking and leak control, are other options.

5. Retail purchasing options if insurance doesn't work out:
- Nu-Hope’s website offers limited models for $30 each.
- ParthenonProducts.com carries the full line of Nu-Hope belts.

6. Persistence can pay off:
- Request a formal denial from Medicare and forward it to the secondary insurer for payment.
- Keep detailed records of all communications and order numbers. If the supplier refuses to bill, escalate the issue within the DME or file a grievance with Medicare.
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