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How do ostomy supplies work with insurance- rx for each order?

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Posted 4/19/2013 10:20 PM (GMT 0)
Just wondering how ostomy supplies work with ones insurance. Do you need a separate rx when ordering each type of supply? I imagine after my surgery I will be given a few boxes full of initial supplies and presumably wont be messing around with different types of wafers, bags, seals, lotions/potions/powders etc other than what I am initially taught, for the first couple weeks at least but would kind if like to start ordering some other stuff right away after surgery to have on hand.
Posted 4/19/2013 10:53 PM (GMT 0)
At least for me my woc nurse sent an rx to my supplier for what she was sending me how with. I've changed my brands a few times and I believe they contact my dr before sending. I haven't had to do anything else and my supplier automatically submits to my insurance carrier.

When you get comfortable with your pouching system you may want to contact the manufacturers via their website for samples. The stuff hospitals send you home with aren't always the nicest...clear bags and clips sux!
Posted 4/19/2013 11:13 PM (GMT 0)
The ostomy nurse was going to do that for us too. We would have had to apply for some sort of "disability" grant from the government (I think you get $600 per year towards supplies). I didn't want to claim this for my daughter (not "disabled") but the nurse said if we didn't do this then our insurance company wouldn't cover the rest of our supplies. Strange set up. Are you going to Mayo? I'm sure they'll set it all up for you there.
Posted 4/19/2013 11:25 PM (GMT 0)
Thanks. Oh, it's hilarious, I am now in a total remission gotta love it! Going through with it though. I am not gonna get thrown off by my colon's games, and i am still tapering through 12.5 mg pred and I kniw there is underlying endoscopic inflammation, after a short, sharp, uceris-induced flare. I guess I should be thankful that I will gointo surgery in full remission, but it does make it feel a bit wierd after all the years of indecision, oh well.
Posted 4/19/2013 11:37 PM (GMT 0)
I had a home health care nurse come to my house 3 days after I got home from the hosptial and she set up an account with a medical supply company. She had all my insurance info already so it was just a quick setup with the supply company. Also, I was sent home with some supplies and I had some already at home that I had sent to me from both Coloplast and Hollister as samples. I have Medica and all my supplies are covered at 90% once I've met my out-of-pocket of $300 for the year.

All my procedures and doctors are part of the United Health Care system so my records and info are accessible to all the various providers which makes things go so much more smoothly.

Keep in mind that you will probably go through several styles before you find the one that works best for you. I urge you to contact the customer care person at the various manufactorers with any questions. They have seen and heard it all so are better equipt to answer questions and assist you. Plus, they are more than willing to send as many samples as you need to get the right product. Also find a WOC nurse if you haven't already or one isn't assigned to you in the hospital.

Best of luck to you.
Posted 4/20/2013 1:14 AM (GMT 0)
My colon started behaving really well before I had surgery too!

I placed an order with edgepark (and online pharmacy). They had me enter my Dr. contact info. They must have done something because pretty soon I had a secondary Dr. listed and I had no idea who it was (still at Cleveland Clinic) so they much authorize with your Dr. or something. I also entered my insurance info.

Then I just go on their website and order supplied. I get told how much I have to co-pay.

They must check with the Dr. when my order changes significantly. I had to order some special supplies and they took a few extra days.
Posted 4/20/2013 1:24 AM (GMT 0)
The hospital won't send you home with very much, so you will probably need to make an order before you leave. At least my hospital didn't. The ET nurse helped us set up the account, well my husband actually I was drugged, lol.
Don't count on your home health care nurse to be able to help you much. As a general rule they aren't trained with ostomies. You may get lucky and get a good one though. Mine suggested that to keep it from filling up with gas so fast I poke a small hole in it with a safety pin. That's not a recipe for disaster at all! :D
Posted 4/20/2013 1:45 AM (GMT 0)
The hospital sent me home with a few supplies and a list of medical supply businesses. The first one on the list was also the closest one to my house. So I went there. They took care of the insurance billings.
Posted 4/20/2013 3:33 AM (GMT 0)
summerstorm, funny you mention the home care nurses. Mine suggested that if I want to go swimming, I just take off the bag and wafer and cover my ostomy with some gauze. Also probably not the best advice for an always outputting ileostomy ;).
Posted 4/20/2013 10:37 AM (GMT 0)
I got very little from the hospital, but the home nurse came within 3 days and left more supplies and ordered samples. Mine was a WOCN so he knew what he was doing! He set up an account with a supplier (Edgepark) and gave them my insurance and dr info. They told me my co-pay (for me, it's 10%) and they said they will call me each month when I am eligible for a next order to see what I want/need.

Alison
Posted 4/21/2013 12:51 PM (GMT 0)
I have Aetna insurance, met my deductible and out of pocket max in early Feb. after 2nd surgery and 25 days in hospital due to perforated bowel (toothpick!!!).  Had colostomy placed after 2nd surgery.  I've found calling Hollister and Coloplast and Edgepark Medical and Sterling Medical Supply and asking for lots of samples is the way to go!  You will find what works for you and what doesn't! 

Once you set up an account with Edgepark or Sterling Medical Supply, you just have to reorder when you need to and they file with insurance.  Both are excellent companies to work with and are so great on the phone!!

 I've found I really like the Hollister mini drainable bags and a product called "Sure Seal" by Coloplast.  These are C shaped pieces of thin rubber that are great for leakage prone areas.  I currently have an open wound and a wound vacuum on so I have one area I use the Sure Seals as I can wear the appliance for about a day at this point without leakage! 

The samples are free so you can try lots of different wafers, bags (not the transparent ones!!), moldable rings, sure seals, etc. 

Best Wishes,

Aimeemusic

Perf. Bowel, Dec. 2012

Colo Vaginal Fistula, Colostomy Placement, Feb. 2013

3rd Surgery for open wound, wound vacuum placement April 2013

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