Ostomy Appliances & Seals: How do you pay for them? Insurance or On Your Own?

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Regular Member

Date Joined Jan 2011
Total Posts : 423
   Posted 2/6/2011 10:24 PM (GMT -6)   
Since deciding I will be having a permanent ileostomy later this year, I have been checking out the prices of supplies.
Omiflippingoodness !!!   I had no clue they were so expensive.  My insurance will pay for 80% but only once my deductible has been met.  This year it will be $750, and of course the surgery will take care of that for this year.  I am worried about next year, already, and I expect my deductible will then jump to $1000.
I have read many of your posts about Eakin seals, Sure Seals, and Adapt rings.  I am planning on needing these because many of you sing their praises when it comes to leaks and longer wear.   I fully expect leaks with my body type.
Are these seals generally covered by insurance or just wafers & bags?  
If you don't mind sharing, I would like to know:
1. Do you have insurance or are you are on your own? 
2. Those with insurance, does a deductible have to be met first?
3.  Either way, do you get your supplies from a local pharmacy or order online and if so, from where?
Perhaps this is a little too personal and I shouldn't be asking.  I was just totally blown away by the prices on ostomy supplies and am not sure I will be able to afford them.  
Thanks for your help, CJ

Veteran Member

Date Joined Aug 2006
Total Posts : 6571
   Posted 2/6/2011 10:29 PM (GMT -6)   
it depends so much on each insurance plan.
The insurance i have right now only pays for wafers and bags and paste/seals. I have to meet a deductible, like 1000, then its all paid for.
The insurance i had before paid for everything, at 80% after a deductible, but i can't remember how much.
So now i pay for my sureseals, gel tabs, and m9 myself, i get them from bestbuyostomy and it's not too bad expensive. Even if i have to buy the wafers and such myself it was like 32 a box for wafers. which isn't cheap, but isnt as bad as if you look at a site that does take insurance
your insurance company will dictate where you buy supplies from. Some sites don't take insurance, hence the cheaper prices, they don't have to eat the costs and deal with the hassles. I use edgepark for stuff that i do run through insurance.
good luck!
you can get some stuff on ebay too, but im a little hesitant about wafers because i don't know how they are stored. I think geltabs, or m9 would be fine from there, but i wouldnt' get any of the important stuff from there.
UC for 8 years, before finally kicking its butt and having a permanent ileostomy April 17 2007!
-I have gone to find myself, if i get back before i return, keep me here-
No matter what kind of day you are having, take five minutes to sing loudly and dance like a fool!

Regular Member

Date Joined Oct 2007
Total Posts : 318
   Posted 2/6/2011 10:37 PM (GMT -6)   
ditto on each plan being different.
If you have a deductible, then the bags and wafers will count towards that and usually eakin and adapt seals too since for many people they are absolutely medically necessary. But yes a deductible will have to be met before they will be be covered completely. A lot of the extras tend to be covered as well. My old insurance covered everything, even sure seals Which seems to be the most common item not covered. I used edgepark with my old insurance but with the new which has a high deductible and then only pays for 50% until I reach the max out of pocket of $5000 I am going to try to find some cheaper suppliers. Remember google is your friend in searching for good deals :)
-diagnosed with UC Dec 2006 at 22
-allergic or intolerant to all 5ASAs, sulfa and 6-mp
-emergency transverse colostomy on 9/13/10 from perforated colon
-J-pouch surgery scheduled 3/21/11

Another UC wife
Veteran Member

Date Joined Jun 2007
Total Posts : 2111
   Posted 2/7/2011 8:26 AM (GMT -6)   
We use Edgepark also but are lucky in that we have excellent ins. coverage. Definitely compare prices ahead of time with other suppliers so your ultimate overall out of pocket with the 20% after you meet your deductible is less for you.

The hospital will use a certain type of wafer and pouch which we are still using 7 weeks later. We called for samples from 2 companies so far. The only change we have made so far is the type of pouch and prefer it to the one we were using.

Trial and error to see what works the best for you. Good luck.
64 yr old male --suffered with UC & in May 06 had a severe flare & hospitalized 6 days...various prednisone treatments leading to steroid dependence and osteopenia, 12 asacol, 200 mg Imuran, failed remicade infusions Jan-May 2010 Dependence on pain meds. Made decision in 6/10 to have surgery which was on 12/17/10 (permanent ileostomy - unable to have the j-pouch) and no longer in pain.

Veteran Member

Date Joined Feb 2010
Total Posts : 720
   Posted 2/7/2011 12:21 PM (GMT -6)   
I pay 20% which isn't applicable to my deductible or my out-of-pocket maximum for the year... it is just separate. What really bugs me is that there is also a $2000 yearly maximum on "supplemental" durable medical equipment with my plan, so once my insurance has paid out $2000 for my ostomy supplies, they will stop covering them. Then I have to pay 100% of the costs for the rest. It doesn't take long to reach $2000 with ostomy supplies. There would be no limit to what my insurance would pay if ostomy supplies fell into their "basic" durable medical equipment category... but they don't consider them basic for some reason. I don't get why ostomy supplies would be "supplemental". You certainly can't have an ostomy without them. ugh! My insurance company only works with Byram so that is where I get my supplies.

What also bugs me is that Remicade, which is super duper expensive, would have been more covered by my insurance than my ostomy supplies. I just don't understand.

I try not to think about it. I need what I need for my health and will have to sacrifice in other areas of my budget. It is hard though and makes me worry for the future if anything ever happened to my job. Universal health care anyone?
-Officially diagnosed with UC in 2006, though had symptoms since 1999.
-Had mild/moderate symptoms continuously until severe flare in autumn 2010 which required 2-week hospital stay
-Took Asacol, Rowasa, Canasa and Prednisone to manage flares but meds stopped working
-Tried 1 infusion of Remicade but had excruciating joint pain and discontinued
-Had permanent ileostomy surgery 11/8/2010

Veteran Member

Date Joined Apr 2009
Total Posts : 587
   Posted 2/7/2011 6:11 PM (GMT -6)   
I have aetna and they said I had to pay 50%. That stressed me out because of all of our medical bills. Well, I just got my eob today and they covered it all. I think because we reached our $2500 out of pocket max due to my surgery. Thank goodness. One less bill to worry about.
Diagnosed 2006. 1st step of 2 step j-pouch 1/3/11. 2nd step will be in April! So done with this disease.

Equestrian Mom
Veteran Member

Date Joined Mar 2008
Total Posts : 3115
   Posted 2/8/2011 7:34 PM (GMT -6)   
I get my pouches, wafers and Eakin Seals from Edgepark (my insurance covers a portion of those) but I buy things like Sure Seals that aren't covered by my insurance through one of those cheap online places...makes a BIG difference:)
Crohn’s dx 1989
some terrible years before my
temporary ileo in 2001
Proctocolectomy w/end ileo in 2008
...wish I knew then what I know NOW!
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