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Five days and counting... but question about cost of ostomy supplies

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Posted 11/2/2012 8:37 PM (GMT 0)
I have my permanent colostomy with end ileo on Wednesday, November 7. Needless to say, I am getting stressed, nervous, excited, mean, grumpy, wacky, etc. My emotions are all over the place. Deep sigh!

My question however is on another note, sort of. I have to select my insurance plan for 2013 and I am trying to get a handle on how much ostomy supplies cost per year. Can you give me a ballpark?

Also, what exactly falls under Durable Medical Equipment? So confusing!
Thanks for your help.
Debbie
Posted 11/2/2012 8:48 PM (GMT 0)
The ins before hubby went on Medicare covered everything for his ostomy supplies categorized as DME. I assumed it was going to be like prescriptions with copays until I delved into it.

Under Medicare and his supplement we pay nothing out of pocket and I believe it is still under the category of DME.

Before you select your ins for 2013 see if you can get a chart or something that specifically spells out what they do or do not cover for DME, if there are deductibles or an annual limit for same. If they follow the Medicare standard it usually is for 20 pouches per month...hubby uses one piece units. If you use a 2 piece unit I'm not sure how many wafers are allowed for every 20 bags.

Do you have an actual supplier lined up yet? Not totally necessary but I did that for my husband before the hospital so that when we came home and ordering was up to us the preliminary acct was already established. But....we had the insurance in place at the time to do so.
Posted 11/2/2012 11:21 PM (GMT 0)
I'm not really sure about cost -still new myself - but I know my insurance covers 100% of my ostomy supplies, which I can say is really nice to not have one more thing to worry about.
Posted 11/2/2012 11:34 PM (GMT 0)
Hi, I don't have a supplier set up yet because I have no idea what type of supplies will work best for me. unfortunately, I will have to pay for 20 percent of the supplies after I reach my deductible, which sucks.

Like why dont they just pay for everything. Like I want a freakin' bag sitting on me, now you make me pay for it too! Funny thing is, is that I work at a health insurance company.
Posted 11/3/2012 11:36 AM (GMT 0)
It doesn't make a whole lot of difference what supplier you choose, as long as they are approved by your insurance, unless you think you need something special. Even then you can order from a different supplier if your regular one doesn't carry a product.

I would suggest choosing a supplier in your area so you can get faster delivery. My regular stuff usually comes the next day.

I asked my surgeon for a prescription for an ostomy hernia belt and had to order that from a different supplier. The people at the manufacturer, Hope, told me a couple of suppliers that were covered by my insurance for this product. I also checked with my insurance. I wish my doc had told me there was up to a 60% chance of getting a hernia with a lap colostomy. I would have started using this way before actually getting the hernia!

I think my insurance pays for this stuff after I reach my "out-of-pocket" limit. I hit that before I needed to order, so I'm not sure. The insurance company will tell you.

I needed to get more adhesive remover packets and was at my limit for the month, but I found a local supplier/supply house that had them on hand locally. They were $15 plus a gallon of gas to get there. My regular supplier gets real upset if I don't order all my supplies at once. They use moderately large boxes even for a little box of wipes, so I understand their frustration. I'm not getting enough supplies per month because of having to change the works at least every other day. It's the smell that gets me, and I've tried all deodorizing schemes and products without success.
Posted 11/3/2012 3:05 PM (GMT 0)
It is indeed a shame and injustice that some of the insurance coverages out there so many deal with are so restrictive and so much "out of pocket". This is medically necessary and as such the coverage certainly should be better.

In the beginning it was a tad overwhelming trying various products to find the one that was best suited for my husband. Of course you come home with the hospital one you are outfitted with. The samples from the various companies help you find your way. You certainly need to know the circumference of your stoma for your wafer and for the first month or so it will keep changing in size so you need to measure each time to cut the wafer's opening accordingly.

Upon discharge from the hospital we were given an original order signed by the Dr with the various type of supplies needed along with the diagnosis code and type of surgery he had. This was faxed to the distributor for the first order. His nurse was very helpful as I had the catalog from Edgepark already and she sat with me and marked the different "color coded" supplies we needed to order initially. As time went on and he needed to try various manufacturers he settled on a product that worked well for him. (His skin was very sensitive to the outer tape on the wafers and had to go with one that does not have it.)

Definitely call the big 3 manufacturers for samples to try so you are not spending money needlessly when you are in the "trial and error" phase trying to find what works best for you. Hopefully the one you are given at the hospital will be right for you. One of the main things is if you need CONVEXITY or not. So many people have problems with a good fit and or leaking and many times if they are using a flat wafer as opposed to one with some convexity....that is what makes the difference in the appliance performing better.
Posted 11/3/2012 4:06 PM (GMT 0)
It depends a lot on your insurance, I pay nothing up to 2000.00, which iwont spend nearly that much! There are a few things I like to use that they won't cover. The m9, gelx tabs and the little packs of adapt. I get those off ebay for cheap. I wouldn't buy wafers or bags or paste off ebay since you don't know how they have been stored. But that's a good way to get anything your insurane won't pay for.
Posted 11/3/2012 10:56 PM (GMT 0)
Summer storm, what are m9, gelx tabs and adapt?

Thanks everyone for your help. Only four days now. Ugh!
Posted 11/4/2012 2:00 AM (GMT 0)
M9 is a pouch deodorizer and the adapt tubes I am assuming are the Hollister Adapt paste? I dont' know about the gelx? Maybe the little packets you can put in your pouch that help a more liquidy output to turn a gel like consistency? I have those but they are made by another company called Cymed and they are called ile-sorb packets.

I'm sorry I cannot help with the insurance costs, etc. I am very fortunate that my amazing husband serves our country and in such we have wonderful coverage for my supplies. If you get familiar with an ostomy association in your area you may be able to network with others who have things they won't use anymore b/c they chose another product, or in the instance where someone needed those remover wipes there may be someone locally that can spare a dozen or so until your order comes. I just stopped by my WOCN office on Thursday b/c for some reason my order was being held up from being shipped and I needed a couple things to tide me over.

A good relationship with your doc/surgeon is key as they sign all that stuff - at least mine does. Maybe it is different for different insurance companies? I actually am over the allowable limit every month but I have an order on my account from my surgeon that says I am allowed to order over the limit due to extenuating circumstances surrounding my surgery - pyoderma causes me to need to change my setup roughly every 36 hours so I am go through more than the allowable each month.

When my box comes it doesnt' even list prices so I can't even help there. And the prices they give on the website specifically say that they will be less if covered by private insurance.
Posted 11/4/2012 4:45 PM (GMT 0)
Gelx are little pills you can put in your bag and the turn it thicker. Its actually the stuff in those little packs in pocketbooks or shoes that say "do not eat"
The adapt packs are little packs of deodorizing lubricant that you can take with you. Its like m9 in a ketchup pack. I like them cause I can put one in my pocket and if I have to empty when I'm out somewhere I can use that and it won't smell the next time I empty.
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