Posted 2/17/2019 12:37 PM (GMT 0)
Hi All
I'm starting a new job and switching insurances. Switching insurances is always the hard part because no one can give me a straight answer on how many supplies are covered or the cost allowance. One insurance company was very particular about their billing that all my ostomy supplies claims were rejected in 2018! the supplier now need to go through an appeal process because they are not set up to bill it the way the insurance wants it!
Now with the insurance I can't get a straight answer whether ostomy supplies fall in the category of Durable Medical Equipment (DME) which gives examples of wheelchairs, walkers, crutches, and oxygen tanks or non-durable such as disposable dressing and bandages.Their health bulletin state that medicare considers ostomy supplies to be prosthetic and classifies the supplies as DME, but it doesn't state how they consider ostomy supplies to be categorized.
My past insurance handbook categorize ostomy supplies as non-durable which make sense as my bags only last 3-4 days and definitely does not take over any colon functions.
The problem lies in the coinsurance. DMEs are covered at 50% while non-durable is at 90%. Does anyone else have this issue?