This topic is about understanding why insurance plans often limit the number of ostomy bag changes to 20 per month and exploring options for obtaining more if needed. The person who started the discussion wants to change their ostomy appliance more frequently than every three days and is curious if others have successfully received a higher monthly allowance.

Here are some helpful insights and advice shared by others:

1. Coverage Differences:
- Private employer insurance plans can be more generous than Medicare. For example, one person mentioned receiving up to 40 bags per month with private insurance.
- Medicare usually sticks to the 20-bag limit. Some people buy extra supplies from places like Amazon before switching to Medicare to have a backup.

2. How to Request More Supplies:
- Insurance companies assume a 3- to 4-day wear time for 20 bags per month.
- A doctor’s prescription or medical justification can help override this limit. One person’s doctor successfully prescribed 30 bags. It's important that the request comes from the doctor, as calling the insurer yourself might not be enough.

3. Closed vs. Drainable Pouches:
- The 20-per-month limit mainly applies to drainable (open-end) systems.
- Switching to closed-end pouches can result in a higher monthly allowance. For instance, one person is allowed 60 closed pouches and 20 wafers for a colostomy.
- For urostomy or any open-ended bags, the 20-per-month limit often remains.

4. One-Piece vs. Two-Piece Systems:
- Using a two-piece system allows you to leave the wafer/flange on the skin longer while changing the pouch more frequently, which can reduce skin trauma from barrier removal.

5. Skin Protection & Wear-Time Tips:
- Frequent full changes can irritate the skin, with redness being the first warning sign.
- Check under the flange with a mirror in the morning and at night for any discoloration or seepage before deciding to change.
- Extending wear by an extra day or two when there is no leakage may help prevent unnecessary skin damage.

6. Buying Backups:
- Some people purchase extra supplies online, such as from Amazon, to build a personal buffer beyond what insurance covers.

7. Possible Insurer Rationale:
- The limits are intended to match typical wear time and to discourage over-ordering, which could lead to the resale of supplies.