Medicare insurance covers ostomy supplies!!

What is this no-sting spray you speak of?  Sounds like something I would like. I got my insurance to cover 5 catheters and 9 tubes of lube per month. But goodness, it was a pain and took a weeks worth of phone calls. But the GI that prescribes for me is not used to working with K pouch/BCIR so I had to instruct them every step of the way. Plus it was new insurance for me as I moved to a new state. 

posted the no sting info on 'shrinking stoma'

Thanks Janet!

What does everyone get for ostomy supplies monthly? Asking Cleveland Clinic for updated script and they need me to list supplies. I know insurance/Medicare won't cover all, but in "perfect world" what would you put on the list?

medicare will pay for only 1 tube of lube per month, even with doctor's override.  i need 5-6/mont.  i'm ok ordering my own as honesty i felt terrible having our taxes used up on medicare costs.  really, 17+$ per tube?  they cover 1 catheter per month at about 115$ each.  i think that's expensive!!

on line at https://www.hpfystores.com.  shipping was 8$, so total is 2.30$ per tube.  the 20 pack is the best price.  another site, for vet supplies, was almost as inexpensive.  anybody have other sources?  

hope all are well!!  janet

I have a BCIR and I get my catheters from Edgepark for less than $3 each after Medicare pays 80%.  Since I can get up to 6 months use per catheter, the Medicare limit presents no problem for me.  I use the generic lube from Walmart at a cost of $1.98 per tube which lasts me over 2 weeks.  Everyone’s use is different, but the annual cost is way less than for ostomy bags and related supplies.

I use Edgepark too and I know it can be expensive, but like Bill stated, nowhere near as expensive as ostomy supplies.  I priced Amazon and Edgepark still comes out cheaper on the items I use. 

Question on catheters: the stoma nurse at the Cleveland Clinic said I could use the catheters 'forever' so if I have them, I don't need to replace them.  Other than the sanitary reason, why do you all replace your catheters?  Thanks! kara

Kara

Your nurse is mistaken. It is a good idea to replace the catheters about every six months because of deteriotion to mostly the tip end where the holes are. over time the tube will weaken and I have known a person who actually lost the tip in the pouch which had to be extracted out by a doctor.

ray

the cleveland nurses said use them as long as you want, but at columbia the nurse said absolutely not and to replace every month.  they do get a bit wonky and my valve is happier with the monthly rotation.

as for prices.  thanks bill for the walmart tip.  they deliver for no charge so it's the best deal around.  to clarify the medicare prices:    edge park charges medicare 114.81$ for a catheter and 17.70$ for a tube of lube!  my supplementary picks up what medicare doesn't cover so in theory i wouldn't have to pay anything for my 5 tubes per month.  this was an eye opener for me about medicare costs.  i see doctor's billings and hospital admittance prices, but have nothing to compare it to.  my liberal inclinations prevents me from needlessly driving up medicare prices--albeit a drop in the bucket--when i can afford to buy my own lube.  the added benefit is that i don't have to pursue edge park people to send the extra lube.  spent woefully too much time on that so happy to drop it.  janet

Has anyone had issues getting catheters without a urology diagnosis?  I’m trying to work with Edgepark but no one seems to understand what diagnosis code to use to get insurance to cover it. Last month I had to talk to 4 people and explain the Kpouch before they figured it out. This month I’m being told again that I need a urology diagnosis to get a catheter. I’ve even asked for a supervisor. Is it Edgepark or am I doing something wrong?  Are other companies easier to work with?

Unfortunately, the rep you talked with is probably a doofus who does not know the difference between a catheter and a garden hose.  I use Byram for catheters. and have had no problems.

I also have a problem with medicare covering more than one tube a month. The  surgilube tube is 4 1/2 oz, so i had to switch to another brand thAt was 4 oz. I think i finally ordered from amazon, but I don't remember the price.

i have been using vitamin e oil and pour it into a small squeeze bottle (got at REI, but they don,t have them anymore) Thank you to Sharon from Paris for suggesting olive oil also. When I mentioned the oil to Dr. Shen, even he seemed surprised!

I also get catheters from edgepark and change them about every 1-2 months.

BillV posted:

Unfortunately, the rep you talked with is probably a doofus who does not know the difference between a catheter and a garden hose.  I use Byram for catheters. and have had no problems.

Thanks Bill. I just ordered a catalog from Byram. I have had issues every month with Edgepark saying my insurance won’t cover a catheter for an ileostomy. No matter how many times I explain it, no one puts enough notes in my account for the next person to avoid issues. Today I was told to call my doctor and get the correct diagnosis code that will allow insurance to cover it. I don’t think that should be my job. They should have saved whatever code they got from my doctor last month when I had to wait 3 weeks for a resolution. They won’t even send me lube because of this. This is so frustrating. 

I think most of problem is Edge Park. I’ve had quite a few problems with them understanding what I need. That said, the nurse should be calling in the order and work out the code. I’ve given up on getting more than one lube tube per month because Medicare won’t cover,  even if the nurse or doctor says it is necessary.     in fact I don’t  get any lube from them because i was bothered as to how much they charge the government. I simply couldn’t be a part of that scheme or whatever it is —My small contribution for keeping down medical costs. Ha. I can get a 4 ounce tube for 2$ including ship, so long as I order 20 or so.Each time I order I really Google for the best price.

Walmart sells a 3oz tube of generic lube for 88 cents (same as KY).  I use mineral oil and get a 16 oz bottle for under 3 bucks and it lasts me just over a year.

I wanted to use coconut oil but my nurses said not to use any type of oils on/in the tubes or stoma. I’ll try Walmart tomorrow. 

I am using edgepark and have been since surgery. I tried a couple companies and they were actually the best of the bunch. I do remember doing some back and forth at the beginning, but eventually I got to the right customer service agent. I think I had to push to talk to someone familiar with Gastro supplies and not urology or general... and I definitely remember having had one of the helpful CC stoma nurses call them as well. Now things work like clockwork... I haven’t been able to get them to auto ship though, but that may be my BC ins., I just have to go online and request a reorder every month.

No matter how many tubes or lubes I ask for (I’ve tried anywhere from 1-8) I get them and they are covered by my ins. I think at some point early on I told CC what I needed in the script and they just ok’d it. (8 catheters and surgilubes, various tapes and bandages, 60cc piston syringe, etc.)  I also got EdgePark to send (and BC to cover) these great Allevyn Life silicone absobant bandages someone showed me when I was at CC last year. I was having lots of skin issues with mucus absorbency and tapes/glues of various solutions I had tried and these work perfect for me... now my surrounding skin is literally indistinguishable from the rest of my belly! The doc told them I needed them and I was just asked how many I needed “per change” (referring to my stoma as a “wound site” ) I use each one for two changes and change 4x/day so I get 60/month.

To Shavon, I know there is info in my account that they reference which indicates condition, doctor, and wound, so it doesn’t make sense that you would have to explain every month if they have that on file for you. Definitely call to explain your problem and plead nicely to escalate to a more senior CS person — It shouldn’t be too hard to straighten out where the process is breaking down once you get the right person. And make sure you have the appropriate contact at your doctors office calling in as they could be a part of the problem as well if they’re not communicating correctly. 

Jennifer