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Supplies and insurance

Posted by Rosiesmom, on Tue May 22, 2018 7:22 pm

hi, do you have any comments re: insurance coverage for your supplies.I finally get enough, but it takes a lot of jumping through hoops. Newest prob. Was new g.p. No other ostomy patients. Had to do a lot of hand holding till they submitted the right script and letter of necessity since I require more pouches per month than the basic one box the insurance offers. Even now just about every month require a phone call to get it right,

Reply by Bill, on Wed May 23, 2018 1:42 am

Hello Rosiesmum. Here in the UK we have 'National Insurance'and the NHS to deal with things like prescriptions and supplies. Some G.P.'s take it upon themselves to be guardians and gatekeepers for the system as if it is their money we are spending, which can make it a bit difficult when we want something new (or more). My own G.P. has only a passing interest in stomas and usually suggests that I visit the stoma nurses for advice. He is however, very helpful when it comes to my experimentation with new stuff and is quite happy to sign prescriptions for things that I have never used before. Nowadays, I don't even have to visit him as I can order things online. For me, it's all about about knowing exactly what I want and need, so that I can be knowledgeable and assertive in my requests. Rarely, I will discuss things with the stoma nurses and present them with a documented version of the problems and my attempts to resolve them. so that it is easy for them to write to the G.P. with their own recommendations (usually identical to mine!) Most often, the nurses will  be able to supply me with what I need from Hospital supplies so I don't need to bother the G.P. at all. 

Best wishes

Bill

Reply by Sasquatch, on Wed May 23, 2018 6:48 am

I've never had a problem with prescription changes, my surgeon is the one who gets the call if there are changes.

Reply by Rosiesmom, on Thu May 24, 2018 2:29 pm

Thanks for the input. I am familiar with N.H.S. As I grew up in Edinburgh. Happy to hear that things are so straight forward. Not so much here as ins. Co. Can be a bit tight fisted at times. If they had to deal with pouches etc. perhaps they woul be more understanding. Having said that this is the firs month since Aug. of last year that it went to plan for my May supplies.yeah 

Reply by Pinky, on Mon May 28, 2018 3:48 pm

Just wait until you have Medicare! Talk about jumping through hoops! I've been ordering supplies since 2009 and I can count on one hand the number of times my order has gone through without extra phone calls and wait times on delivery. I use Edgepark - largest supply company, supposed "easy" 3 month orders via internet, etc. There is nearly always a problem, though not from my doctor's office.

Hate to think if we ever get universal healthcare here in the US it will be based on the Medicare system. Last time my order was held up based on my middle initial - after 13 years on Medicare with the same middle initial!

Reply by Texasmade, on Tue May 29, 2018 12:35 pm

Dealing with insurance for supplies can be a nightmare. I've had my ostomy and not had it reversed by choice for 5 years. It's the insurance companies - trying to get them to understand that one box is not enough to last a month. Bottom line - you have to get your doctor actively involved. They have to write a prescription and fax it to the insurance co. I wish I could tell you better news, but the insurance co. (all of them) are about money, not you or me. Telling them, as well as anyone who increases our monthly bills by a few dollars, that those few dollars add up and our monthly income does not increase.  They simply don't care. This is not meant to be negative; it's just reality. Maybe others feel differently.

Reply by freedancer, on Tue May 29, 2018 2:32 pm

Are you a veteran?  If so then your supplies are free.  If you are a vet, go to the closest out patient clinic and sign up for services.  You can talk to them about getting the supplies.  They mail or deliver mine right to my door.

Reply by Morning glory , on Thu May 31, 2018 9:09 am

Hi pinky, I agree with you on jumping through hoops with Medicare. I just experienced this for the first time a few weeks ago. The cost for two boxes of five per box threw me for a loop. I have to change twice a week; at over $86.00!

The weight time was ridiculous. I was getting very worried,good thing I had a couple of extras. This is a real hardship to have to pay this much money for something you absolutely cannot do without.

Reply by Rosiesmom, on Thu May 31, 2018 1:04 pm

Hi morning glory, I guess we all have issues with ins. And supplies. I have 

Medicare with a supplemental. I get so disgusted at times. This last supply order for June was the first since Aug. of last year that it went according to my script and letter of necessity in place. I use Coloplast sensura wafers, if this is what you use I would be willing to send you some, after all we have to stick together. We just need to figure out how to get in touch. I am not a full member but would be willing to post my email add. Unless someone knows another way. Take care

gail aka rosiesmom

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