My insurance will not pay for my ostomy supplies ordered by my doctor.

[WillieW]

I received a bill from the company that sends shipments of my Ostomy supplies to me. Medicare paid 80%, but my secondary will not pay the balance. I have a presciption from my doctor, but they claim they only pay for presciptions. Well Duh, I have a prescritpion. What the heck!

Any advice?

[mitchtv]

1. they should pay get all your paper andd

call them again, sounds clerical

[damntexdem]

2. Do they pay for Medical Supplies?

You may need a prescription for them, but they are listed as supplies, not prescription drugs.

A related question: do they pay for Durable Medical Equipment?

[juajen]

3. Call the company and tell them that "You just want to speak

to their Ombudsman before you go public with this action on their part." This sometimes will get you somewhere. Good luck!

[WillieW]

5. The funny thing is that they waited over a year to deny my claim.

[elleng]

10. NOT funny,

took them that long to get their nerve up. Get back at them quickly, with your evidence of prescription.

[BlueDemKev]

4. Read over exactly what your plan says

I know that's a pain, but it has to be done. They cover prescriptions, but what are the exclusions/exceptions. Is this a non-generic drug? See if there's a generic equivalent which is cheaper that your insurance company would pay for.

If it turns out you are responsible for the full amount, talk to your pharmacist and see if you can work out a payment plan for the prescription (of course, I don't know how much it costs, or how often you'll have to get it refilled).

Hope this helps. Have a good weekend.

[WillieW]

7. thanks will do.

[SoCalDem]

6. Our son has a urostomy, and many yars ago, our insurance denied payment

I called and got a "manager" and let him have it.. I asked him this question.

"When you need to pee, do you use the toilet?".....silence...more silence..

Then I reminded him that our 8 yr old son would LOVE to be able to do that too, but the medical procedures he HAD to have, made that impossible for him, and the ONLY way he had to eliminate urine, was with a urostomy bag & wafer, ( at $65 or so back then, per box), and it was a medical necessity, until Ziploc came out with an affordable work-around.. They mailed us a check for reimbursement ane never questioned it again..

[WillieW]

8. Good advice. Will call on Monday asking a similar question.

[truedelphi]

9. Sorry to hear about this.

I relate because at one time I was scheduled for surgery that would have possibly left me needing those supplies for life.

A simple $ 14 bottle of acidophilus saved me from needing the surgery - and no one of the doctors or speicalists I had talked to had ever mentioned that I might end up experiencing this hassle and expense for the rest of my life. It was all "This surgery is the best way to deal with your condition of diverticulitis."

You might wanna figure out how many different manufacturers of your supplies exist Then see if any of them has as a parent company any of the Big Pharma company with a "Plan for the Poor"

Those plans offer the poor person a discount or even wipe out the cost of the items. But you have to furnish your income tax forms for the past two years (If I remember correctly)

And I don't know wh5t their guide lines are as to what constitutes poverty, etc.

[WillieW]

11. I have colon cancer and need these supplies for life.

[TygrBright]

12. I'd say empty a coupla bags into a Ziploc, tape it securely into one of those Fedex boxes...

...and send it along to your insurance company's headquarters, with a letter asking what they want you to do with this stuff, since they won't pay for your supplies.

helpfully,
Bright

[WillieW]

13. I might get myself in trouble doing this.

[WillowTree]

14. A doctor can write a prescription for Kleenex, but that doesn't make it a prescription drug.

If your policy doesn't cover medical supplies, you're out of luck on this one.

[WillieW]

15. There is a difference between Kleenex and necessary medical supplies.