This topic is about a change in health insurance coverage that has affected how ostomy supplies are classified. Previously considered "durable medical equipment," these supplies are now categorized as "medical supplies," which means a $2,500 deductible must be met before any costs are covered. This change has led to higher out-of-pocket expenses for the person involved. Here are some insights and advice shared by others in similar situations:
- The individual is paying $275 every two weeks for an employee-only insurance plan and is looking for ways to manage the increased costs. They are seeking help from charities or organizations that assist with supply costs, advice on involving the state insurance commissioner, and general strategies to reduce expenses.
- When comparing vendors, it was found that Liberator Medical offers prices roughly 50% lower than Midwest Medical. The hope is that the employer might reconsider the current insurance plan, although there is skepticism about whether future federal changes will help.
- It's recommended to shop around with multiple distributors, as many offer prices lower than those billed to insurers. For example, RTA Medical Equipment offers a full-year supply for about $1,000 with free shipping when ordering in bulk. Other low-cost online suppliers include MedicalMega.com, STL Medical Supply, and ExpressMedicalSupply.com. Price comparisons show significant savings, such as a box of 20 Eakins seals costing $203 at Edgepark/Liberator versus $89 plus $6 shipping at MedicalMega.
- Individual resellers like Scott Amiot in Phoenix, AZ, offer Hollister and ConvaTec products at reasonable prices.
- For insurance tactics, it's suggested to have the prescribing physician state that supplies are "medically necessary" on the prescription, which might help in getting better reimbursement. Informing the employer's HR or benefits office about the negative impact of the new plan could lead to renegotiation. Contacting the state insurance commissioner might be an option if the reclassification seems inconsistent with previous standards.
- Opinions on policy changes are mixed. Some believe that the Affordable Care Act exchanges might offer better coverage for ostomy supplies, while others expect costs to rise. Long-time users have noted significant price increases over the years and call for government scrutiny of manufacturers, though some argue that regulation itself contributes to higher prices.
- To manage costs, consider purchasing larger quantities to meet free-shipping minimums and offset expenses with small lifestyle changes, like bringing lunch to work.
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