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Do You Have To Pay For Your Supplies???

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Posted by vulcanBMk2, on Thu Aug 21, 2008 2:02 pm
Its strange reading through some peoples posts, that some of you have to pay for your Ostomy supplies. Here in the UK , I just go to the Docs.Sign my ready printed presciption & they send it direct to Charter Healthcare ( My Suppliers) 2-3 days later my supplies arrive , Delivered by Parcel Force.  I usually order every 4-5 weeks .  I get 30 Welland Uro pouches.. 30  Ptotective Wipes . 10 Colorplast Night bags, This company also throws in , Gratis, 2 packs disposal bags, 2 packs Dry wipes & 1 large general wet wipes.  I often complain about the British National Health Service... but my surgeon was brilliant... I get free supplies & I dont pay a penny!!! Very Happy
 
Reply by tarababy, on Thu Aug 21, 2008 6:27 pm
Hi Vulcan, here in Australia..Queensland anyway.(not sure on other states,but presume they are the same)..we pay to join up to the ostomy association..every year, then when we order supplies,we pay also..Now its $10 a mth or $15 for 2 mths.In that you get 4 boxes of waifers and 4 boxes of bags and then 4 stomahesive pastes.Thats 4 of each for each mth too.Anything else you want you put it on the order and they send it.I have had to order extras,and never got charged more.I'm glad we pay,means they can keep doing research to find solutions or new appliances.And also glad we dont pay through the nose for things that are important to an ostomate.Not like we asked to be in this situation hey.ok take it easy...Tara
 
Reply by mooza, on Sat Aug 23, 2008 8:15 am
here in melbourne we pay a yearly membership fee of $40 concession or $55 this is a one off fee .You order your supplies every month or so.I think this is a very good scheme. U can pick up or get your supplies sent of a cost of $9.00 a parcel
 
Reply by vulcanBMk2, on Sat Aug 23, 2008 9:52 am
I am not too sure wether under 60's have to pay anything in England... But the over 60's ( Like Me Twisted Evil ) get all prescriptions free Very Happy
 
Reply by erika, on Sat Aug 23, 2008 4:08 pm
hi everyone, yes im under 60 and get all my supplies free as do all permanent ostomates  i get 60  bags per month also wipes and black disposable bags  and can also get deo spray free also . we r very lucky here in uk i guess.
 
Reply by Garlon, on Sat Aug 30, 2008 1:37 pm
                                 
vulcanBMk2 wrote:
Its strange reading through some peoples posts, that some of you have to pay for your Ostomy supplies. Here in the UK , I just go to the Docs.Sign my ready printed presciption & they send it direct to Charter Healthcare ( My Suppliers) 2-3 days later my supplies arrive , Delivered by Parcel Force.  I usually order every 4-5 weeks .  I get 30 Welland Uro pouches.. 30  Ptotective Wipes . 10 Colorplast Night bags, This company also throws in , Gratis, 2 packs disposal bags, 2 packs Dry wipes & 1 large general wet wipes.  I often complain about the British National Health Service... but my surgeon was brilliant... I get free supplies & I dont pay a penny!!! Very Happy




I live here in san antonio, texas, and the insurance companys consider urostomy supplys a )band aid) An will not pay for any of it
 
Reply by bamatex, on Sat Aug 30, 2008 2:04 pm
I live in Texas & get all my supplies without charge to me. But it depends entirely on what kind of insurance you have, mine happens to be very good. As for Medicare, I'm not sure how much they pay or what kind of co-pay is involved. I'll know when I go on Medicare.
 
Nurse
Reply by Whoa, on Sun Aug 31, 2008 2:39 pm
Ahhhh, the USA and insurance.  Long winded, but here goes and hope this helps someone:

First, anyone can buy ostomy supplies without a prescription.  To get insurance to PAY for it though, you must have an MD prescription.   An experienced or good ostomy supply company will often help you through the process, whether Medicare or managed care which needs authorization.  

Most inurance companies follow Medicare guidelines in tems of what items are covered and how much insurance will pay.  Confusing, but in general  Medicare  will pay for 80% of what Medicare deems allowable as the cost and for "allowable" (standard used) items.  The 20% balance is up to you; if you have a secondary insurance they will usually pick up the balance.  Example:  If your pouches cost $100 and Medicare allows/covers $100 for that particular supply, they will pay $80 of it (80%).  Balance is yours to pay if no seondary insurance.  If they only allow $50 coverage for that particular product, then they will only pay 80% of the 50 bucks, even if the item you want costs $100.   Meaning, they would pay $40 on that item, and you would pay $60 out of your pocket if no secondary insurance.   It gets messy.   Suggestion:  if Medicare, look for an ostomy supply company that "accepts assignment" from Medicare.  This means they bill Medicare directly, and accept whatever payment (measly?) Medicare will give them, you don't have to put money out of pocket or wait to get reimbursed.  It can get sticky, as some  ostomy items are not ocovered or they will not accept assignment on certain things/brands.

Private insurances:  (Managed care HMO and PPOs)  all plans vary; some won't pay for ostomy supplies period though that is rare.   some have a co-pay, either percent of cost or flat fee.   The KEY:  get authorization, go to he company they CONTRACT with.  It is a PITA....but not impossible.    Many HMOs first line is to deny, deny.  Be persistant, check your insurance booklet.  It should becovered under "prosthetics"   If still refused, write a letter of appeal.   I have done this for patients who needed more supplies than the usual allowance for imperfect stomas or personal reasons and insurance saw the logic. with the physician countersigning.  Sometimes they are even more generous than Medicare (if they don't know better!)  Call your insurance provider and ask who they contract with and to provide authorization.  They may ask you for a list of supplies, or have you go to your primary MD or surgeon and they will put it through the process for you.

Be aware...a lot of folks think they have Medicare when in fact they have signed that over to a managed care Senior Health plan.  That is OK...but if you have done that, you need to go with the ostomy supply company that plan contracted with or you will be responsible for the charges.   If a home care nurse is seeing you and you are under Medicare, that home care is being PAID by MEDICARE to provide you with ostomy products as long as the home care nurse is seeing you....if you order supplies while under home care, Medicfare will NOT pay for them until you have been discharged by that home care agency.

Medicaid/Medical (called different names in different states):  My experience is lately they are trying to dictate what brand you wear to keep their costs down.  So, they may not cover certain Convatec items, but would cover the same thing in another line such as Hollister or Coloplast.  All good companies, check with your ostomy nurse though on what is the equivalent......I have issues with a person on the phone who has never seen a stoma much less the patient looking at a catalogue making clinical judgements on ostomy wear, telling them it is "equivalent"...they don't know the whole picture.  Check with your ostomy nurse first if they won't give you what you are asking for.

My last suggestions:  If you have NO insurance or your ostomy items really aren' covered, there are a lot of companies that will actually give a CASH discount...but you have to ask.  Be active in your local or national ostomy associations: politicians have been trying to get ostomy item coverage taken out of both Medicare and Medical/Medicaid in the past....it was the ostomates who prevented that from happening.  Supplies sure are not cheap out of pocket!

Easy, huh??? Rolling Eyes

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
 
Reply by vulcanBMk2, on Sun Aug 31, 2008 2:59 pm
Laughing  Well thats it then!!  Exclamation  I/m staying put In England Razz
 
Reply by tarababy, on Sun Aug 31, 2008 11:43 pm
Yep, now that puts the States as a holiday destination....I'm staying right here in Oz thanks...Hey anywhere is good for a holiday, if you can get one hey..Thanks Whoa...
 
Reply by dlgates, on Fri Sep 05, 2008 5:24 pm
Hello, Bamatex. I am 66 and therefore on Medicare. It pays for all significant ostomy supplies. You have to buy your own disposable gloves, saline solution, a few things like that, but all the high-price items are taken care of.
 
Reply by mazz, on Sat Sep 06, 2008 5:17 am
hi i in england and i dont pay for anthing i need and ive gone for the best of everything. I get it delivered the next day they even pick up my perscription for it all i just sit back and wait for them to send it. I am having a reversal next week and have just had a big delivery will have loads spare if the surgery goes well. i could post the stuff to someone who needs it if they pay for the postage theres about 30 one piece pouches for everyday wear. 30 small swim pouches, barrier repair wipes, glue remover, bags, wipes, mirror, travel bag, hand cleanser, leakage tape, 10 sealed one pieace pouches for going out on the townso if anyones interested leave me a message take care all go in on thurs for the op.
 
Reply by cancerfree, on Sun Oct 12, 2008 4:57 am
Here in Ontario, Canada the provincial goverment gives you $300 every six months (for permanent ostomies). If you do not have private insurance coverage through your employer you are pretty much on your own to foot the rest of the damages, which you would be able to claim on your income tax (but who knows how you would be receive back, it surely would not be 100%). I know other provinces have their own legislation and some do actually cover everything if you order within their guidelines. Rolling Eyes
 
Reply by Belinda, on Sun Oct 19, 2008 8:03 am
Terribly unfair that you guys in the US have to pay for your bags etc. We are so lucky (if having an Ileo IS lucky) to get supplies free if the Ileo is permanent here in England. Hi Tara et al. Hope you're OK. Rolling Eyes
 
Reply by sitNpriti, on Sun Oct 19, 2008 11:18 pm
Hi All...I'm here in Ohio and have had my colostomy for a year now and my insurance is Medicare and a Supplemental ins. I do have a co-pay depending on what I order for the month which isn't all that much but sometimes I just order straight from a supply company and pay out of pocket instead thus avoiding the hassle. It would be so much better if we didn't have to have all the red tape to go through....ah well. such is life.

Regards....

Priti
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