Reimbursement for supplies from medical insurance

[DiaperedCarpenter]

Good afternoon everyone, new to the site here. Is anybody familiar with reimbursement for medical UI supplies? Was recently diagnosed with BPH and OAB but have had issues for about 5 yrs now. Any information is useful at this time. Thanks

[FretaBWet]

This seems to be a regular question here on DD best answered with a couple questions. Where do you live? This is important because that can make a big difference. If in the US, are you disabled? BPH and OAB are not a disability where you are incapable of working. If you are disabled and unable to work you may be able to get help with supplies depending on what your disability is how your doctors feel about it since they would have to sign off on your need.

Hugs,

Freta

[DiaperedCarpenter]

I am in Missouri, I can get the Dr signature. I’m not disabled and work but my insurance is not Medicare or state provided. 

[WetDad]

I am US as well, and have a high deductible insurance plan. So I use my HSA card to pay for my supplies. Yes, I have a note from my Dr as well, but the IRS has not asked for it yet.

[FretaBWet]

We’re right next door in Kansas, hi neighbor. We used to live in Independence MO. I am retired and on social security and also have OAB and urge incontinence. I have incontinence on my medical records for my entire life in some form or other. I’ve also had surgery to try to cure it when I was around 11. I am 24/7 and pay for my diapers and supplies out of pocket. Without a complete disability it is unlikely that you will get any help with your supplies. Here in the US, insurance companies will do everything in their power to avoid paying for anything. They view all the money they take in for premiums as their money and every cent they pay out for care as taking their profits. The only time they willingly throw money at someone is if you are a lobbyist or politician. They consider those two groups as a good investment. Good luck on your quest.

Hugs,

freta

[ppdude]

I am in Michigan on Medicare with additional private insurance. No state or local agency will help with or reimburse for diaper and associated costs. If you can't afford the diapers, you'll make a mess out of your clothing and furniture. No Medicaid reimbursement either. I just don't know how @brian gets his stuff paid for. Guess I need to move to Vermont.

 

[Kawaharu]

Unless you have a disability or HSA or FSA, your paying for your diapers on your own, pal

[~Brian~]

18 hours ago, ppdude said:

If you can't afford the diapers, you'll make a mess out of your clothing and furniture. No Medicaid reimbursement either. I just don't know how @brian gets his stuff paid for. Guess I need to move to Vermont.

 

@ppdude

you are correct: the problem is that people need diapers or incontinence supplies, so they end up reciprocating and giving them all they want or all they need. The difficulty is is that they give us enough stuff to be able to load 10 tractor trailers an hour, but it's not very good quality, so they can get away with giving us thousands of these first three cents a piece. When I was using the crappy diapers, I was getting 300 of all products combined. So I think I was getting 150 diapers 150 chucks.

Medicaid does pay for diapers.There are a lot of things that Medicare will not cover either . This is why I have both . Medicaid always would cover diapers for adults if they have a disability , and they will do it for children who have need of diapers after a certain age as well, provided they have a disability as well. The problem becomes that what they did was they always give you the cheapest possible cloth backed incontinence briefs, which aren't worth anything, and there is about as thin as a bounty paper towel , and who wants to have a bounty paper towel wrapped around them or something of that equivalent when you really have to use the bathroom . A diaper is supposed to be something that you can release full on in if it's necessary . This is why it is necessary to have plastic back diapers. There are people who have total loss of continents, and they can't just go and stop all day long and keep on doing this. If they have to go bad enough, they're going and you can't stop them. This is why you have to have good product.

to answer your question Sir: I had to use the prevail air diapers for almost a month, possibly two months before they would even consider me for an upgrade to better diapers. I told them that I was to be considered totally incontinent both ways, which basically means severe incontinence. Told them that when I want to use the thing, or need to use it, I need to use it. There is no Start Stop Start Stop Start Stop- once you start, you're going to keep on going until you're empty. Better diapers would allow for that.

I had to do some homework myself: the Medicaid people in my state asked me for my top five diapers, and I had to provide them. Once I did that, they wanted me to rank them one to five, mega Max being the top, a supreme being #2, and an M4 being #3, and then there are a couple other ones. The idea here is I wanted plastic backed and not some cheap knockoff that wouldn't be able to hold water. An incontinence brief is supposed to be used for that purpose, so it should be built to be able to do exactly what it claims to be able to do.

I also had my doctor write on my medical records that I had medical necessity for the diapers I was requesting. My medical diagnosis is written as continuous leakage of urine, and fecal incontinence with fecal urgency. I had the doctor write that so that I would have no problem getting the diapers that I needed. He also had to provide medical documentation to back up my claim, and he was able to do that quite easily, because I've had cerebral palsy all my life, and that in and of itself can cause incontinence in certain people because of certain situations, including urge incontinence. The doctor calls it functional incontinence officially, but to me it's full incontinence, because I can't be playing games and worrying about whether I'm going to make it to the bathroom or not. If you are incontinent you need better than just the low end stuff. Total incontinence requires that you have better management tools and better garments.

Once I was able to prove that I needed better diapers, I had the diagnosis, I had tried the prevail air diapers which we know are useless, I have a disability, and I have proven that the diapers they gave me didn't work, the state said that they would cover my mega maxes, further they stated that they would continue to cover mega maxes because those diapers work for me. It is not my intention to change diapers again, unless of course something requires it. I played medicaids game, by the rules, and did exactly what they wanted. I was told that my diapers and my chucks and my boosters would be covered. The only thing that they don't cover are wipes, and topicals. For that, my home health agency takes care of that with special funds that I'm allowed to use for this purpose, or things that would help me live a better life or be more functional.

@Kawaharu

18 hours ago, Kawaharu said:

Unless you have a disability or HSA or FSA, your paying for your diapers on your own, pal

you have to be able to prove medical necessity and medical need. I was easily able to do that with my doctor's assistance and all of my diagnosis. I do not know the first thing about all the things that he would have to write, but there are certain things that I have to be able to prove, and I know them well. Medicaid will cover diapers for young children as well, under the doctor dinosaur program in the state of Vermont. I don't know if the child Medicaid covers things that the adult one does not, but I would think that if you had a young child that was past the traditional diaper age, that needed it, or any other support stuff like that, they would be able to get that covered by programs and things called Med waivers, because that is usually how they do it. Being that I have been disabled all my life, there are certain things that I remember from my childhood and what they used to do. Things have changed over the years, but the most important thing is they still want you to prove medical necessity and medical need. I was worried about being able to cover that, because I was more worried about having accidents, and knew that it would be hard for me to prove it, but the doctor told me that he would take care of me, and he did.

I'm not sure how other state Medicaid agencies go, but believe you me, there are even problems in vermont's case. You are allowed to ask Medicaid to cover anything, but they don't have to, and they will give you the answer one way or the other that it's approved or denied. When I asked them about covering wipes, it took them eight months to get me a decision, and then they didn't even tell me. I had to go all the way to the Medicaid ombudsman's office to be able to get somebody from Medicaid to look at the situation and give me an answer. Thank God for my home health agency because they were able to cover things that I needed to make my life easier. Wearing diapers is no problem, but you have to make sure that you have what you need. There are times however, that fsas are hsas are pretty awesome because they will cover most things that other traditional insurances will not. The ironic thing is, when I go to these places to do my research, which is what I did before I even made a decision on what diaper to use, every company that made cloth back diapers told me that their products were crap, and that they pay, if they have either relatives or children that have disabilities or elderly parents or elderly relatives, for diapers or incontinence products are support products out of their own pockets. The ironic thing is they want to push their crappy product on us, but they know darn well that it's not the best. I keep saying that the best thing that would happen to some of these companies would be to put them in a position where they have to wear diapers, and they have to wear their crappy diapers and they have to wear them for long periods of time, and I bet you money that if they had the chance between their diapers that they peddled to us, and a mega Max or the best diaper in the world whatever that be, they would be crying and begging for a mega Max after two hours, because they would have so much rash and redness and problem that they wouldn't be able to deal with it.

@Kawaharu is very correct when she says, unless you have the proper insurance, you'll be paying for your diapers out of your own pocket, pal. She knows exactly what she has to use, and probably knows about everything there is to know that she needs to know about her situation. Each person has a differing situation, and a differing level of disability or condition. The ironic thing is, sometimes you have to make yourself sound worse than you actually are, in order to get something that you absolutely need.

Brian

[Kawaharu]

That's why unless you have a medical disability, have an employer FSA or HSA, your coving your diapers on your own. In my case, I have a medical disability and I have my diapers covered as well 

[FretaBWet]

Just to be clear, Medicaid is a state run program not a federal run program. Each state receives federal money to help fund it but states must supply any funds beyond what they get from the federal government. Each state sets it's own rules on what they will pay and how much they will pay.

I've seen many people sneer at "liberals" and liberal politicians. I've seen many people call Vermont and it's leaders  "socialists" like it's a terrible disease. I've seen Bernie mocked for his beliefs that people matter. If you're living in a conservative state you're not likely to get much help from Medicaid because those states look at you like a deadbeat and spend their time and energy designing laws to give you the barest minimum. So the answer is Brian is lucky to be in Vermont because as a state they care.

Hugs,

Freta