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Posted 8/19/2015 12:16 AM (GMT 0)
This is going to sound really dumb - especially since i've been ordering stuff left and right though my insurance but, how do you know what the limit of items is?

People tell me you can only get so much of this and so many of that, like, for example 10 wafers and 20 pouches or something.

I order through edgepark and I feel like no one has been straightforward about this information.

Is there a limit?

smilewinkgrin
Posted 8/19/2015 12:40 AM (GMT 0)
That would be a question for your insurance company. However,I would not ask. As long as you can get what you need don't wake up the sleeping giant.
Posted 8/19/2015 4:06 AM (GMT 0)
I used to order through Byram. They would tell me what limits my insurance company set. The numbers they told me were a little weird and didn't always make sense but I never had an issue.
Posted 8/20/2015 7:51 PM (GMT 0)
It does just depend on your insurance company. At the time of my operation, I had Personal Choice, Pa Blue Cross and Blue Shield...excellent insurance. They covered EVERYTHING and I mean Everything. I never received a bill nor did I ever receive a statement from the hospital or my surgeon. Like Dad said....I never asked either. However, I have been on Medicare for the last four years and they are a different story rolleyes I am glad I listened to my husband and stock piled supplies while still with Personal Choice! Would you believe Medicare said ok to the Reliamed drops and stoma powder, but denied the bags??? What morons! Well, we got it all ironed out in a month's time, but glad I had extra boxes on hand.
Posted 8/20/2015 11:49 PM (GMT 0)
Your supplier should be able to tell you what your insurance limits are -- they're the ones with the vested interest in finding out your limit (they want to sell you exactly the maximum of what your insurance will cover so they can get paid). I had very good insurance when I had my ostomy and I could get up to 20 two-piece wafers and bags per month or 30 one-pieces.
Posted 8/21/2015 2:48 PM (GMT 0)
I have never been able to get a straight answer on this. Aetna told me I have no insurance-mandated limits. Edge Park told me I'm limited to what the doctor prescribed. My doctor told me he didn't set any limits. I agree with the others - don't rock the boat! If no one is limiting you now, hoard, hoard, hoard! You never know when your coverage will change, or what the future may hold.
Posted 8/21/2015 4:03 PM (GMT 0)
I think i have the same situation as you bania. The problem is that they bug your doctor whenever you order stuff. I feel bad... edgepark said i should only need a new prescription when I am ordering items with different numbers than what i've ordered in the past, but i am not sure how it works. They called my doctor for a prescription for a pair of underwear, seriously. Oh well, i guess that's better than being on a limited number of supplies.
Posted 8/21/2015 8:17 PM (GMT 0)
Yeah, they bug the doctor all the time. It's so ridiculous. Don't feel bad about your doctor being bothered. The staff handles it and (one would hope) it's all electronic anyway so they just click and you're good. And it's way better to have your doctor in charge of quantities than the insurance company.
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