Ostomy supplies and health plan/medicare

coloCan
coloCan Member Posts: 1,944 Member
edited November 2014 in Colorectal Cancer #1

Last month, i received two boxes of bags,not the three i had ordered but thought nothing of it as long as i was billed for two.......Just got off the phone with bag supplier pertaining to my november order-which i haven't received yet- and was told i had exceeded amount allowed (again, i asked for three boxes of bags,one of wafer and one of adhesive remover). I replied that every since my op i was alloted three boxes of bags/month. Woman said as of Oct,2014 health plan had changed maximum to two boxes/month. I then called health plan and eventually reached a real person and was told since medicare allows only two boxes of bags a month so will health plan from now on (no one had so informed me until five minutes ago)

To fellow ostomates:any of you have similar problem this month? I tried explaining that while i try to keep bag as long as possible(practical) there is no control over stoma output to guarantee need for new bag every day and a half. Obviously idiot who made this decision does not need a bag to live.......Those on medicare:is there a two box limit/month on bags? (i switch to medicare-if it still exists-latter part of 2015).......Those not yet on medicare:are your supplies so limited? Getting 30 bags a month is alot better than 20......i

This really pissed me off!!!!!!!!!If i knew who was responsible for this decision you know where my next bag i need to replace will get sent.......

 

PS A few months after surgery i paid on my own for several boxes of supplies off the internet so i would always have an adequate supply on hand if any production problem at convatec or UPS/Fedex strike,terror attack,whatever, as you can't get this stuff at CVS or the local drug store/med supply)

 

 

 

 

Comments

  • JanJan63
    JanJan63 Member Posts: 2,478 Member
    #2
    I live in Alberta, Canada and

    I live in Alberta, Canada and our health care system pays for 75% of the costs up front so we don't have to wait to get it back. They're bloody expensive! I don't know if there's a limit per year, though.  

  • Lovekitties
    Lovekitties Member Posts: 3,364 Member
    #3
    Medicare coverage

    Ostomy supplies are covered as "durable equipment" under Part B of Medicare.

    Here is the page which tells about coverage  http://www.medicare.gov/coverage/ostomy-supplies.html

    I also have a supplemental plan F which covers the 20% co-pay and deductibles for Medicare.  So mine cost nothing out of pocket.

    I have not had any difficulty with standard order.

    Perhaps your doctor needs to contact the insurance company to restate your medical need amount, since that seems to be what Medicare goes by if over and above any "standard" amount.

    Marie who loves kitties

  • Fight for my love
    Fight for my love Member Posts: 1,522 Member
    #4
    If I were you, I would be

    If I were you, I would be pissed off too. My husband just had a pelvic exenteration, this basily means they took everything out of pelvic, so my husband ended up with both urostomy and colostomy( although he has been having colostomy for 5 years). I got to say the change from one stoma to two stomas is not easy, he is still in the middle of the transfer of managing both stomas at the same time. As expected, so many accidents happened in the last 2 weeks, we have been constantly cleaning up the mess and changing his bags and wafers. He has private insurance from company, but the policy has been changing every year, I also worry what it is going to impact his supply in the future due to the policy change. Sorry I can't give you any suggestions. Hope this issue will be resolved soon.

  • fatbob2010
    fatbob2010 Member Posts: 467 Member
    #5
    Sounds Like Good Advise

    Marie's suggestion to have doctor contact insurer is probably where I would start.

  • coloCan
    coloCan Member Posts: 1,944 Member
    #6
    fatbob2010 said:

    Sounds Like Good Advise

    Marie's suggestion to have doctor contact insurer is probably where I would start.

    thanks......

    Health plan claims change due to OPM (i'm a federal retiree);also said OPM supplied them (health plan) with my birthdate-which is off by two days;took 12 minutes to get that info via phone from health plan. To reach OPM by phone-office of personnel mgmt-is impossible and their website is not working properly right now.......I've accumulated a good supply of bags,wafers,adhesive removers over the years but i still want 30 bags/month so now i have to contact surgeon(who only has office hours on mondays to write another request for my supplies but getting thru to opm to correct my birthdate for health plan is proving hercluean.....Imagine that,after 64 years i now have to prove when i was  born;next i'll have to prove i have a stoma

    (Storytime:a few years ago i got called for jury duty,which i had served several times while working(got full pay but backed me up in my paperwork and i was still responsible for what happened at work) so i asked my onc for a note but not to give much detail as who knows how "private" such info will be. She wrote that i have extreme difficulty sitting and concentrating.

    Made sure i was first on line at court so first on line at excuse window. Gave the young woman my note and i observed her face as  she looked at it. Then i said:"Look at the name of the facility on the letterhead"-a cancer center-and then:" look at doctor's title"-oncologist-and then i said: "Look at this" and lifted up my shirts and exposed my bag-covered stoma......Her eyes widened and she said she'd be right back. She went to her boss,then the xerox,gave me copy of my note plus form signed by her boss excusing me from jury duty forever)

    Going over medicare supplement plans is going to be onerous and time-consuming, as i have meds i need daily plus an inhaler,plus my bags,etc and all the other goodies we now need,like CEA tests,CT/PET scans,doctor visits,etc. And i still need to get my date of birth corrected......Compared to the events in my life these past 5 1/2 years,nothing to it (or should be but dealing with 800 numbers and bureaucracies can really be frustrating and nerve wracking and give one nasty thoughts that aren't good for one's sanity)

     

     

     

     

     

    )........

  • coloCan
    coloCan Member Posts: 1,944 Member
    #7
    coloCan said:

    thanks......

    Health plan claims change due to OPM (i'm a federal retiree);also said OPM supplied them (health plan) with my birthdate-which is off by two days;took 12 minutes to get that info via phone from health plan. To reach OPM by phone-office of personnel mgmt-is impossible and their website is not working properly right now.......I've accumulated a good supply of bags,wafers,adhesive removers over the years but i still want 30 bags/month so now i have to contact surgeon(who only has office hours on mondays to write another request for my supplies but getting thru to opm to correct my birthdate for health plan is proving hercluean.....Imagine that,after 64 years i now have to prove when i was  born;next i'll have to prove i have a stoma

    (Storytime:a few years ago i got called for jury duty,which i had served several times while working(got full pay but backed me up in my paperwork and i was still responsible for what happened at work) so i asked my onc for a note but not to give much detail as who knows how "private" such info will be. She wrote that i have extreme difficulty sitting and concentrating.

    Made sure i was first on line at court so first on line at excuse window. Gave the young woman my note and i observed her face as  she looked at it. Then i said:"Look at the name of the facility on the letterhead"-a cancer center-and then:" look at doctor's title"-oncologist-and then i said: "Look at this" and lifted up my shirts and exposed my bag-covered stoma......Her eyes widened and she said she'd be right back. She went to her boss,then the xerox,gave me copy of my note plus form signed by her boss excusing me from jury duty forever)

    Going over medicare supplement plans is going to be onerous and time-consuming, as i have meds i need daily plus an inhaler,plus my bags,etc and all the other goodies we now need,like CEA tests,CT/PET scans,doctor visits,etc. And i still need to get my date of birth corrected......Compared to the events in my life these past 5 1/2 years,nothing to it (or should be but dealing with 800 numbers and bureaucracies can really be frustrating and nerve wracking and give one nasty thoughts that aren't good for one's sanity)

     

     

     

     

     

    )........

    Took another thirty minutes to finally get to speak with

    someone at OPM and she typed up (as she couldn't get thru to health plan via phone)on gov't letterhead request to correct my birth date so now i'll see how long it takes and if it corrects health plan info on me...................Other issues i'll deal with in time

     

    "Meaugh,myoweee" (ask your kitties, Ms Marie and they'll tell yiou that means "thanks for the suggestion" in cat talk (i've had three of them,one at a time;with my last cat,we also had girlfriend's Doberman. Can't deal with losing another pet like a cat or dog so GF got me a white rat;Rosie's two years old now) 

    Don't know anything about Canadian health care system,Ms JanJan tho i have read a few interesting items about the CRC research by a Dr **** from somewhere in Canada

    To go from need for one bag to two(and i'm sure newest stoma is different size  than original, with a mind of its own)i can empathize with you and your husband as you fight for your love and yourself, Ms Fight for my love

    and you're right Fatbob about contacting doctor (for whatever reason surgeon was the doc who had signed off on my very first request for ostomy supplies so til he retires, that;s who i'll go to)

    Aint no other site gonna know what its like.....................................steve

  • sammer4u
    sammer4u Member Posts: 37
    #8
    Not right!

    I would definately fight this.  No one can determine what supplies are needed, or estimate how many you will go through.  All I can say is send your fuil bags to Obama!  He is not helping matters any!  

  • Lovekitties
    Lovekitties Member Posts: 3,364 Member
    #9
    coloCan said:

    thanks......

    Health plan claims change due to OPM (i'm a federal retiree);also said OPM supplied them (health plan) with my birthdate-which is off by two days;took 12 minutes to get that info via phone from health plan. To reach OPM by phone-office of personnel mgmt-is impossible and their website is not working properly right now.......I've accumulated a good supply of bags,wafers,adhesive removers over the years but i still want 30 bags/month so now i have to contact surgeon(who only has office hours on mondays to write another request for my supplies but getting thru to opm to correct my birthdate for health plan is proving hercluean.....Imagine that,after 64 years i now have to prove when i was  born;next i'll have to prove i have a stoma

    (Storytime:a few years ago i got called for jury duty,which i had served several times while working(got full pay but backed me up in my paperwork and i was still responsible for what happened at work) so i asked my onc for a note but not to give much detail as who knows how "private" such info will be. She wrote that i have extreme difficulty sitting and concentrating.

    Made sure i was first on line at court so first on line at excuse window. Gave the young woman my note and i observed her face as  she looked at it. Then i said:"Look at the name of the facility on the letterhead"-a cancer center-and then:" look at doctor's title"-oncologist-and then i said: "Look at this" and lifted up my shirts and exposed my bag-covered stoma......Her eyes widened and she said she'd be right back. She went to her boss,then the xerox,gave me copy of my note plus form signed by her boss excusing me from jury duty forever)

    Going over medicare supplement plans is going to be onerous and time-consuming, as i have meds i need daily plus an inhaler,plus my bags,etc and all the other goodies we now need,like CEA tests,CT/PET scans,doctor visits,etc. And i still need to get my date of birth corrected......Compared to the events in my life these past 5 1/2 years,nothing to it (or should be but dealing with 800 numbers and bureaucracies can really be frustrating and nerve wracking and give one nasty thoughts that aren't good for one's sanity)

     

     

     

     

     

    )........

    About supplemental plans

    There are several options available when you become eligible for Medicare.

    The basics...Medicare Part A and Part B.  To opt out of even the basics would be a disaster...no coverage.

    Next, you can choose  a supplmental plan in addition to the basic.  These are the same regardless of insurer...cost may vary depending on location or carriers group population.  I have plan F which covers any Medicare eligible expense, pays the 20% co-pay and the deductibles.  You would have to also get a Plan D in order to have coverage for the prescription meds.  That is the hardest part trying to figure out what level of coverage you need.  Some pharmacies where you get your scripts filled offer to help in the selection based on what you use now.

    Instead of the Basics and supplemental plan, you could opt for an Advantage Plan.  There are various ones of these too.  Some include a drug plan, vison plan, dental plan.  I beleive all have deductibles and co-pays.  These are more like "regular insurance plans", but follow the Medicare eligibility criteria on services and products.  The biggest down side I read about was that if you take this instead of the basic Medicare and then want to change back, it can be difficult to get back into Medicare.

    I would suggest that you start looking now.  I went to AARP to get info to help me get started. 

    Best of luck

    Marie who loves kitties

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