Insurance woes

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Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 12/18/2008 2:16 PM (GMT -6)   
My insurance company, UHC, has denied reimbursement for my ostomy supplies. I plan to appeal, but am so frustrated. How can they deny supplies that are necessary for me to live? Does anyone else have experience or advice with this? Your help is much appreciated.
Dx Mild Proctitis 7/06 at age 33, Dx Severe Pan Colitis 5/07, Dx Crohn's Colitis 10/07
Failed Asacol, Lialda, 6-MP, Canasa, Rowasa, Proctofoam, Entocort, Remicade, Humira
10/10/08 colon removed, temporary ileostomy
11/10/08 FINALLY off prednisone after 18 months
2nd of 3 surgeries planned for Jan '09 to form j-pouch


suebear
Forum Moderator


Date Joined Feb 2006
Total Posts : 5692
   Posted 12/18/2008 3:49 PM (GMT -6)   
Insurance companies don't view ostomy supplies as necessary for life. about 8 years ago some insurance companies began eliminating or reducing coverage to these supplies and I suspect more will follow suit. When I had a temp ostomy my insurance company covered about 60--80% as I recall and that was about 7 years ago.
It doesn't seem fair since they seem to have no problem handing viagra out to any man who asks for it but deny women birth control pills? Don't get me started.

Sue
dx proctitis in 1987
dx UC in 1991, was stable until 1998

1998 started prednisone, asacol, pentasa, nortriptylene, ativan, 6MP, rowasa enemas and suppositories, hydrocortisone enemas, tried the SCD diet, being a vegetarian, omega 3s, flax, pranic healing, yoga, acupuncture, probiotics

2000 lost all my B-12 stores and became anemic

2001 opted for j-pouch surgery- now living life med-free


Wade457
Regular Member


Date Joined Dec 2008
Total Posts : 91
   Posted 12/18/2008 6:54 PM (GMT -6)   
suebear said...
Insurance companies don't view ostomy supplies as necessary for life. about 8 years ago some insurance companies began eliminating or reducing coverage to these supplies and I suspect more will follow suit. When I had a temp ostomy my insurance company covered about 60--80% as I recall and that was about 7 years ago.
It doesn't seem fair since they seem to have no problem handing viagra out to any man who asks for it but deny women birth control pills? Don't get me started.

Sue

This is a major reason why people want national health care.

Health insurance companies only want people who are well and don't need medical care.

If you've got a cold and sniffles, they'll bend over backwards for ways to deny paying any claims.

(getting off the soapbox)

summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6571
   Posted 12/18/2008 8:28 PM (GMT -6)   
someone managed to get their supplies paid for by having it considered prothestics, like for an amputee.

peggy113
Veteran Member


Date Joined Aug 2007
Total Posts : 1998
   Posted 12/19/2008 2:25 AM (GMT -6)   
Back in the early 80's, I can remember that ostomy supplies were definitely covered BUT were listed as prosthetics. You might try that. I can't hardly believe that they would deny coverage. I can see that they might limit the quanity, and that is reasonable. But to deny, that is unreasonable.
Peggy
      
Diagnosed with CD in 1979, many resections and meds
Perm Ileostomy July 1984 at Cleveland Clinic
Disease free since surgery 
 


flchurchlady
Veteran Member


Date Joined Jul 2007
Total Posts : 2765
   Posted 12/19/2008 10:14 AM (GMT -6)   
That is ridiculous! How do they expect us to live without our appliances?! confused

I recommend calling your insurance company and asking them if they have a contract with any suppliers. I found out (by asking) that my insurance company has a contract with Sterling Medical to cover my supplies by 100%, but they don't have that deal with other suppliers.

Good luck!
Dx'd Crohn's in '99 at 28. Proctocolectomy and ileostomy in '06.
Disease-free, medicine-free, and very thankful to be healthy again :)


Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 12/19/2008 8:10 PM (GMT -6)   
Thanks for the suggestions!
Dx Mild Proctitis 7/06 at age 33, Dx Severe Pan Colitis 5/07, Dx Crohn's Colitis 10/07
Failed Asacol, Lialda, 6-MP, Canasa, Rowasa, Proctofoam, Entocort, Remicade, Humira
10/10/08 colon removed, temporary ileostomy
11/10/08 FINALLY off prednisone after 18 months
2nd of 3 surgeries planned for Jan '09 to form j-pouch


Equestrian Mom
Veteran Member


Date Joined Mar 2008
Total Posts : 3115
   Posted 12/19/2008 9:03 PM (GMT -6)   
I have UHC and mine are covered 80/20...it may be the plan you are in...check into other ones provided by your employer when open enrollement comes around. One of them may cover ostomy supplies! Good Luck:)

mikeg999
Regular Member


Date Joined Apr 2008
Total Posts : 61
   Posted 12/28/2008 8:01 PM (GMT -6)   
i had UHC until 12/1> It paid 100% of all items from Edgepark
55 yo male
First UC flare at age 49
All medical approaches failed (including Humira) and opted for total colectomy on 6/17/08. Permanent Ileostomy


Pibbin
Regular Member


Date Joined Apr 2008
Total Posts : 163
   Posted 12/29/2008 2:11 PM (GMT -6)   
Ok, so some more details:

The UHC policy at my hub's employment specifies in it's certificate of coverage that it will not cover disposable medical supplies such as ostomy supplies. It will cover prescribed prosthetics. I have been ordering through Edgepark, who has an rx from my surgeon, and who unsuccessfully billed UHC.

Anyone know how to get it billed as prosthetics -- I'm guessing that Edgepark is already doing that, but should probably make sure...
Dx Mild Proctitis 7/06 at age 33, Dx Severe Pan Colitis 5/07, Dx Crohn's Colitis 10/07
Failed Asacol, Lialda, 6-MP, Canasa, Rowasa, Proctofoam, Entocort, Remicade, Humira
10/10/08 colon removed, temporary ileostomy
11/10/08 FINALLY off prednisone after 18 months
2nd of 3 surgeries planned for Jan '09 to form j-pouch


peggy113
Veteran Member


Date Joined Aug 2007
Total Posts : 1998
   Posted 12/30/2008 7:02 AM (GMT -6)   
Maybe contact Edgepark's billing office and talk directly to them. Maybe they can bill it under a different "code" as a prosthetic for you?
Peggy
      
Diagnosed with CD in 1979, many resections and meds
Perm Ileostomy July 1984 at Cleveland Clinic
Disease free since surgery 
 

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