It has been awhile since I have posted and hate o take up this space For others that have more pressing needs.
However, I am finding myself extremely frustrated at the insurance maze and had hoped some of you might have gone through something similar and had suggestions.
I am posting here as its not specific to KPouches but more insurance based so wanted more eyes on it.
I currently have United Heath Care. I have a KPouch which I normally use an Ampatch, an Ampatch insert and a cotton ball to reduce leakage. I buy the cotton balls over the counter but have been getting the Ampatch and Ampatch inserts (insurance calls them Stoma Caps and Stoma Cap Inserts) covered by insurance since my last surgery over ten years ago.
Earlier this year, United Health Care informed me they were no longer covering the Ampatch Inserts. While not convenient due to my greater than normal leakage (probably the wrong term), I was able to adapt by just changing the Ampatch and cotton ball more frequently. Last week I found out that they have now excluded the Ampatch as well from insurance.
I asked United Health Care if there was an alternative and they stated they were not aware of any.
I spoke to the supplier I had been ordering them from and they directed me back to the insurance on how to approach. I went back through the insurance and they said I could appeal, though likely if it was listed on the exclusion list, I didn't have much hope of gaining coverage.
This seems a bit ridiculous to me that they can just remove something from existing coverage without providing an alternative. I suppose at this point my only option is to try and appeal.
Has anyone else appealed a medical exclusion, and if so what is the best method to approach this?
Thanks in advance for all of your help.
Mike
