Meet & talk to fellow OstoMates 20,338 members

How do I afford my supplies?

Posted by andyangiet, on Mon Apr 27, 2009 7:09 pm
I have had an ostomy off and on for many years, on the last surgery to reconnect I ended up with an Ileostomy. I have to use diffrent bags and my insurance doesn't cover them hardly. I have a perscription for them and I still can't afford to pay the co-pay. I was diagnosed about 4 years ago with Ehlers-Danlos Vascular Type 4. So if you know what that is I already have enough to deal with and now I am having trouble being able to get my supplies cuz of the cost. I have tried serveral different types of bags and found ones that work pretty good and my insurance won't pay for all of it. They said they are to pricey. Can they do that? I need some advice!!!!
Past Member
Reply by Past Member, on Thu Apr 30, 2009 8:58 am
heres a link provided by another member  http://www.ostogroup.org/

i dont know if they can help or not.
Nurse
Reply by Whoa, on Thu Apr 30, 2009 9:48 pm
andyangiet
Unfortuneatly, insurance can do that.  I don't know  your specific insurance, but occ. I have had luck getting a "letter of medical necessity" written and signed by the doctor in obtaining ostomy supplies beyong what the insurance guidelines allowed when nothing else would work for someone...this is in the US and not sure where you are located.

You might also try the link above, your own local ostomy group, or calling the company whose supplies you like..they do want your business and may be willing to work with your insurance company.

I hope this helps.

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
Reply by devilishjim, on Sun May 03, 2009 6:58 pm
And if that doesnt work, then file a grevience with the ins. co.... They get upset when an issue goes to higher authority ( waves do rock the boat )
  good luck
  Jim
Reply by kenkd, on Sun May 03, 2009 7:19 pm
I have had some luck finding supplies on Ebay, where I search for my favorite brands of ostomy supplies (and I won't pay but fifty percent of the retail cost, which is usually outrageously high). This takes a little pre-planning (making sure you have enough supplies to last till you actually find a cheaper provider and the item is actually shipped). Most of the folks I buy from there are good at shipping the item in a timely manner, and they appreciate repeat business. I was even lucky enough to find sellers who had surplus items and really didn't care how much I paid for them as long as I paid the ten dollar shipping cost. They often times sent me more than I ordered, for free.
Good luck,
Ken
Reply by FA1THWLKR, on Tue May 05, 2009 12:50 am
hI i have alot of supplies in which I did not use due to the shrinkage in my stoma after surgery.  I am looking to bless someone with them so if you give me your size and the brand you like then we can see if they will work for you.  No charge I will send them to you for free.
Reply by weewee, on Thu May 07, 2009 1:40 am
you get ur doc to write a note stating thats what you need then if that dont work get ur woc nurse to get u signed up for some of the programs that hollister and other companys have they are really good about it. its not likewalked in and asked to get stuck with a bag dont let them bully u
Reply by jaidre, on Wed May 13, 2009 12:49 pm
hi, i have some extra supplies that i can't use... (samples that i've requested from companies)...that you are welcome to...also, your ostomy nurse can give you a few to tide you over in an emergency...i go to 2 different hospitals and my ostomy nurses are God sends!! my heros!! please let me know what you need...i also have some coloplast... i'm happy to help in any way : )
Reply by keysgirl, on Mon May 25, 2009 12:22 pm
I have used Osto Group when I didn't have insurance...they are a blessing.  They may, or may not, have the exact supplies you need, but I talked to Marian, who took the time to find some supplies that worked for me.  Osto Group is specifically for those who don't have insurance and can't afford to pay the high, and might I add, ridiculous price of ostomy supplies.  Unfortunately we are held hostage to paying the exorbonante price of the supplies because we can't function without them.  Okay, so I'm whining a little bit, but I'm sure many people are confronted with how to afford the supplies.
Reply by sweede, on Wed May 27, 2009 10:33 am
Hi Anyangiet, you still having problems getting pouches lass?
Past Member
Reply by Past Member, on Thu Jun 18, 2009 2:32 pm
                                 
FA1THWLKR wrote:
hI i have alot of supplies in which I did not use due to the shrinkage in my stoma after surgery.  I am looking to bless someone with them so if you give me your size and the brand you like then we can see if they will work for you.  No charge I will send them to you for free.


Last edited by Past Member on Sat Feb 26, 2011 2:55 am; edited 1 time in total
Past Member
Reply by Past Member, on Tue Jul 21, 2009 9:06 pm
I, too, am really glad for all the information here because my insurance only pays for 6 pouches per month, that is all they will "allow" .... who the heck wrote their policies? Good grief.
Reply by junopete, on Tue Jul 28, 2009 10:30 pm
Andyangiet, did you get your supply problems worked out concerning your ostomy needs?
what brand and type of products work the best for you?  Next question, what will work. Not talking about the best.

I have hundreds of wafers and bags and eakin 2" seal rings.  Most of what I have is Convatec.

Rick.....
Past Member
Reply by Past Member, on Sat Aug 01, 2009 12:48 am
                                 
Whoa wrote:
andyangiet
Unfortuneatly, insurance can do that.  I don't know  your specific insurance, but occ. I have had luck getting a "letter of medical necessity" written and signed by the doctor in obtaining ostomy supplies beyong what the insurance guidelines allowed when nothing else would work for someone...this is in the US and not sure where you are located.

You might also try the link above, your own local ostomy group, or calling the company whose supplies you like..they do want your business and may be willing to work with your insurance company.

I hope this helps.




There is a pharmacy here in Wisconsin that is hoping to fight for Ostomates in the Medicare realm to see if there is anything they can do to "up" the number of allowed pouches per month from 20 to at least 30 but ideally 40.  They would like to know more about this "letter of medical necessity" and also have requested that I ask you "how is it then submitted to Medicare?"    Thanks Smile
Nurse
Reply by Whoa, on Sun Aug 02, 2009 7:51 pm
wounded doe

"Letter of medical necessity":  the physician writes a letter which documents the need for more supplies than the guideline amount; this is submitted to the supplier and insurance company.   It has sufficed  for a few of my patients with private and Medicaid insurance groups.  I can't recall if it worked for Medicare, but I would hope they would be reasonable (HOPE!)

Example:
  This letter is a request for an increase  off the allowed number of closed end disposable ostomy pouches for Mr. X to 90/month.  Mr. x  has a diagnosis of rectal Cancer and has a permanent colostomy.  He has essential tremors in his hands which make it impossible to use drainable pouches with closures.  He lives alone and does not have a caregiver to assist him.  He is able to maintain independence with his ostomy appliance using disposable closed end pouches, but requires 90/month to contain stool and maintain hygiene, independence and dignity.  

Signed by MD

give the reason for requesting more than what is allowed; good examples would be : stoma  located in a skin fold or retracted, hernia and surgical relocation is not an option; high output from stoma which disintigrates pouch/wafer integrity; dexterity or mobility issues which make pouches with closures on the end difficult to manage, etc.

Give a reasonable explanation.  Your local supplier may want to submit the letter before giving you the extra supplies. If the insurance comapny denies, file an appeal.  It is not always easy, and sometimes persistance wins.

For submitting to Medicare, I would ask them to submit it to the person they usually bill to for supplies.  They may have to make some phone calls (or you could)...to find out exactly who to submit the letter to.

The UOAA has fought and won  keeping ostomy supplies covered...for now.  With all the cuts coming...it is scarey.  I will try to call one of my local suppliers this week and get a better answer for you on a letter to Medicare.

Good luck!

_________________
* Certified Wound and Ostomy Care Nurse
* Registered Nurse
* Bachelor of Science in Nursing
* 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    
4 members & 16 visitors
lovely (f)
w30bob (m)