Meet & talk to fellow OstoMates 20,168 members

Do You Have To Pay For Your Supplies???

Go to page: Previous  1, 2, 3
 
Posted by Counting My Blessings, on Mon Sep 05, 2011 12:41 am
NO!  not unless there is a snag in delivery or the faxing of the prescription and I have to go to the local medical supply to hold me over.  



If all goes well, Blue Cross pays for the same supplies Medicare allows for.  Since I only need bags, I know I can get 2 boxes of 10 bags (or 20 total) per month.  When I was using 3 bags a day, I DID have to pay for extra bags.  Since the second colostomy, things are great and I have plenty of bags.
 
Reply by Counting My Blessings, on Mon Sep 05, 2011 12:48 am
I don't know if you will save any money at Cymed, but I don't need anything except the bags and clamps anymore.  And they end you large twist ties.  I don't trust them and still use the pink curved clamp for my one-piece drainable pouch with the microderm plus washer.  I never need the adhesive remover, skin prep, caulking or powder with this product.  And the micro skin adhesive patch never bothers my skin in the heat and humidity in Florida.  

So, perhaps you could cut down on expenses with this product, if you can also get to where all you need to purchase is bags.  I believe Cymed will send you a sample.
 
Reply by wondering if, on Fri Nov 18, 2011 7:47 pm
I want to live in England so I won't have to worry about affording my supplies in the near future. Also, I want to live where I can try those new flushable ostomy bags, without having to pay, of course. Any Brits want a roommate or a mail order wife in her fifties? I'm divorced and all my children are going to be famous movie stars, artists, singers, and designers, so they'll surely jet across the pond to see me now and then.  Or I could stay in America and just take a long swim in the Pacific ocean when I run out of money for supplies.  I wouldn't mind being dead, but I'd miss that odd sensation and the ptt ptt noise when a flatus blows through my stoma and into my ostomy bag. People who never feel that just haven't lived like we have, have they?  Or how did we ever exist without experiencing the sheer delight of wiping shit out of a bag, dropping it into the toilet, and snapping the never-to-be-truly-clean-again bag back on to the wafer? I suppose I'll have to find another job with insurance soon.  But I'm so tired.  I could sleep for eternity, and be just as happy.
 
Reply by wondering if, on Fri Nov 18, 2011 8:27 pm
I was just kidding, by the way. I'm neither suicidal nor desperate to marry an Englishman. However...  I would love to live in England and try to flushable bags.
 
Reply by panther, on Sat Nov 19, 2011 5:50 am
I thought it was my lucky day for a minute then lol, I'm single and an Englishman!  
We are very lucky in the UK not having to pay for ostomy supplies.
Glad your ok.
 
Reply by charuthukral, on Fri Dec 16, 2016 8:48 am
Whoa wrote:
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

Hi Whoa,

I am currently writing a paper on ostomy market in US and Europe and have been trying to contact experts from field to understand how the distribution network of these big manufacturers in these regions work. I have gone through the post of most of the ostomates who have commented in this thread and I will surely be including these insights in the paper. I understand that

1) In the US, the patients get their supplies from either online distributors/ market places and if their Medicare covers these purchases they are reimbursed for what ever percentage is predefined like mentioned by one of the ostomates here. I was curious, after surgery hospitals gives some pouches snd accessories to the patirnts. Where do these hospitals get that from? Distributors or manufacturers? Does the hospital bill include the cost of these supplies?

2)In the Europe (correct me if I am wrong), the patients do not have to pay for their supplies they get that for free (in countries including UK, Belgium, netherlands and few others). I have same question as above how do hosipitals procure these pouches that they use on patients soon after surgery. Do patients have to pay for that? or that is also covered?

 
Reply by Angelicamarie, on Thu Dec 22, 2016 11:21 am

Hey Charuthukukral, thanks,  food for thought, so what if you was long winded you gave some good info . Thanks I will check into that!!! Angelicamarie

Go to page: Previous  1, 2, 3
* Please, do not post contact information like email, Facebook or Twitter accounts, or phone number. These will be removed by the Administrator.
All times are GMT - 4 Hours
Currently online: 20    
5 members & 15 visitors
delves (m)
Jennie (f)