Would you consider asking your doctor to write a letter of medical necessity to get your diapers covered by insurance or other payor?

[Enthusi]

I am curious for those who are diaper dependent, would you or have you asked your doctor to write a letter of necessity in the hopes of getting diapers covered?   My doctor said he is willing to help, but it seems like a long shot  

(I wrote this from the perspective of an American, but I would also love to hear from people from other countries as well)  

I’ve looked into it for myself and my understanding is that it’s an uphill struggle the whole way: Most commercial insurance companies don’t cover incontinence products unless you have a qualifying diagnosis.  Even then they will most likely cover generic low quality pull-ups. For them to cover tape-diapers you would need to provide evidence that tape diapers are the only option to manage your incontinence.  This maybe a bit tricky for those of us who untrained. And even then you would have to coordinate with a medical supply distributor in network, who has your preferred brands. If not you would have to work with the distributor to appeal to get premium drapers covered.  

It sounds like a ton of work, but the thought of saving $3000+ per year makes it tempting!  

There’s also the question of if it’s even appropriate to have someone else pay for diapers when you intentionally untrained.   I see both sides of the argument. On one hand incontinence is “self inflicted”. On the other hand, you could make a strong case for the psychological need for diapers, and at this point some of us here (myself included) are as incontinent as any other adult who needs diapers, regardless of the cause.  
 

Cheers!

Enthusi!

[~Brian~]

4 hours ago, Enthusi said:

 I am curious for those who are diaper dependent, would you or have you asked your doctor to write a letter of necessity in the hopes of getting diapers covered?   My doctor said he is willing to help, but it seems like a long shot  

(I wrote this from the perspective of an American, but I would also love to hear from people from other countries as well)  

I’ve looked into it for myself and my understanding is that it’s an uphill struggle the whole way: Most commercial insurance companies don’t cover incontinence products unless you have a qualifying diagnosis.

@Enthusi

My Doctor wrote me that Letter of Medical Necessity, and has all of the needed documentation that are required to take care of my needs for my incontinence diagnosis - They just renew it every 6 months or so, and if anything else is needed, the doctor is told, and he takes care of anything that my supplier does NOT have for my renewals.

First, You would NEED a qualifying diagnosis, (Mine: Cerebral Palsy/Fecal Incontinence with Fecal Urgency/Continuous Leakage of Urine)  and that is why I tell people that they need to have the diagnosis on your medical records, and you also want to make sure that the need for diapers is backed up by the diagnosis on record.  The reason You would want to do this is because IF there is a qualifying diagnosis on your medical records, then NO ONE is gonna balk or complain when you are trying to get what you need.  An example of this is:  What if I am incontinent, and the medical record does NOT indicate that?  If it doesn't do that, asking for diapers probably would be denied.  Because I have the diagnosis on my record, and the proper documentation, they probably would see the records on the wards, and offer me the protection I need:  Of course, I would have the Megamaxes available, but they would give me the "standard briefs" they use, and we know that they are not the best, but as long as you have the right information on your records, it should be easy to get what you need if you are in the hospital or another facility.  That way, the need is documented, and regardless of where you go, people will be watching for it

 

4 hours ago, Enthusi said:

There’s also the question of if it’s even appropriate to have someone else pay for diapers when you intentionally untrained.   I see both sides of the argument. On one hand incontinence is “self inflicted”. On the other hand, you could make a strong case for the psychological need for diapers, and at this point some of us here (myself included) are as incontinent as any other adult who needs diapers, regardless of the cause.  
 

There may be questions of appropriateness, depending on what is going on.  If you try to "hoodwink" the medical system, it MAY blow up in your face!  If you are incontinent like me, because of disability, I DON'T WANT to  have to go through all the urology specialists, and I KNOW I have a neurological disability, and I KNOW what my situation is, and I don't need a "specialist", when my doctor has been taking care of me for 24 years:  If he and I don't have a good relationship, enough that he trusts my judgement, and i trust and respect his judgement:  he is the "specialist" and knows my medical conditions, and he wrote me that letter:  If he couldn't do that, based on my medical condition, we would have an issue, but I don't,   I am glad I have a great medical team, and they take good care of me.  

You CAN make a strong case of the physiological need for diapers, but you would need someone who understands WHY you would make such a request to a doctor, and that doctor would probably make a decision based on need, and how your current health and state of mind is:  I mean @BabyCat2 will probably have to do this as she moves forward in her quest, so that her medical, and physical and physiological needs are met, and she has the team that knows her situation, and about her autism, so she will most likely get what she needs, because she has the backing of her care team, like i have the backing of mine

You probably don't want to deadpan say "I used to be continent, and now I am not, because i 'Untrained myself'" - After a while, you will NEED diapers like every other incontinent person.  I am and I consider myself lucky that I was able to prove medical necessity for them, and I don't have to do that again:  Using the cheap stuff is not even feasible, because I would flood through them - That is why i get the megamaxes - i did my research, and was able to show need and necessity.  I am not getting any younger, and I don't wanna be peeing and pooping on the floor because I cant get there fast enough - I know that has happened many times, and it isn't fun ;(  The doctor probably doesn't need  [I Untrained myself] that info, but you should ALWAYS tell the doctor the TRUTH, because he is working for you, and cannot work effectively if you are hiding something, or lying to him or her!  DON'T EVER DO THAT!!

4 hours ago, Enthusi said:

It sounds like a ton of work, but the thought of saving $3000+ per year makes it tempting!  

If you have the right diagnosis, and proper medical PROOF, then you usually can get what you need.  sometimes, it takes a couple "tweaks" to the Prior Authorization that goes to the Medicaid Division, or it may take medical reports and other things if that isn't enough, but the doctor can usually write what you need, in a way that says you NEED something, so that it is covered.  If you have GOOD insurance, you should be able to get what you want, but sometimes oy can be difficult to get it, depending on what coverage you have.  I am all set, so I have what I need, but I think its like $300/month for what I order, or maybe more, but I can get what I need, because I have a contract for a New Hampshire Supplier to provide me the Megmaxes, and the PA is renewed every 6 months.

Good Luck!

Brian

Edited October 11, 2022 by ~Brian~
Added Additional Information

[Enthusi]

@~Brian~ Thanks as always for your super thoughtful responses! I dig it!

To your point, I too have no desire or need to undergo urologic testing. Simply put, it’s not going to change anything.  I already know why I’m incontinent, and I don’t want any other “treatment.”  I also don’t want to lie to my GP.   On the other hand I realize that it’s a tough sell to explain why diapers and only diapers without going into the nitty gritty about unpotty training.  

[ppdude]

5 hours ago, Enthusi said:

I’ve looked into it for myself...

NOT ONE insurance company EVER in 25 years made it possible for me to get diapers.

NOT even in the stinkin' hospital. They offered me their total crap diaper and I turned them down. At the time, my wife, brought my preferred diaper for them to use.

I've struck out 100% of the time.

 

[Enthusi]

32 minutes ago, ppdude said:

They offered me their total crap diaper and I turned them down.

Funny story!   About a year ago I did see a urologist at the insistence of a specialist and my PCP at the time.  When I got back to the exam room I asked if it was going to be a while because I was due for a change and she asked me if I needed one of their briefs. I naively said sure!  Why would I turn down a free diaper?      The MA comes back a few moments later with this flimsy pull-up. It was basically a large maxi pad held together by some cheap elastic.   I don’t think it could’ve held more than a single wetting.  Needless to say, I politely declined. 
 

[FretaBWet]

I really disagree with this. If your doctor did write a letter so you can get your free premium diapers where do you think the money is coming from? It's coming out of the pockets of the taxpayers. If you had an underlying disease that caused your need I would be completely supportive. You should have considered the cost before you embarked on your untraining journey. You signed up for the journey, you pay for it.

Hugs,

Freta

[cathdiap]

Since it is my personal wish to be incontinent, I don't think it's fair to make the community pay for it. Maybe it would be different if I couldn't function without wearing a diaper, like a medico-psychological need or something. But that's not the case with me.

[Enthusi]

10 hours ago, FretaBWet said:

I really disagree with this. If your doctor did write a letter so you can get your free premium diapers where do you think the money is coming from? It's coming out of the pockets of the taxpayers. If you had an underlying disease that caused your need I would be completely supportive. You should have considered the cost before you embarked on your untraining journey. You signed up for the journey, you pay for it.

Hugs,

Freta

I GREATLY appreciate your response, and frankly I’ve wondered myself if it’s appropriate to ask someone else to pay for diapers when I deliberately untrained myself. Hence why I posted the question!   For what it’s worth I’m still able to afford them. But the cost savings in tempting.  

That said, I do think that the improved mental health as a result of wearing diapers full time has to count for something. Ever since I untrained my anxiety has improved. For me, it just feels right to be in diapers.  I’m living more in line with my authentic self.   To put it more bluntly: A few cases of diapers is a heck of a lot cheaper than long term psychotherapy.  ?

[Kawaharu]

I disagree because unless you have a VALID medical reason for a doctor to write you diapers on your medical record, your on your own on this one. You have to have a legit medical reason for why a doctor should write that you need diapers on your medical record. I have rarely seen doctors write letters for someone who needs diapers for personal reasons. Doctors will only write a letter stating you need diapers if you have a VALID medical reason and medical condition that requires you to be permanently in diapers 24/7/365

In my case, I have a legit, valid medical reason why my doctors write on my medical record that I need them because of my incontinence and my medical conditions. It's on my medical records and every time I go see my doctors, they always know it's on my medical records that I am incontinent and I am medically required to be in diapers. It's why every time I go see them, they always run a diaper check on me and make sure I am using them properly.

If you want diapers so badly, don't expect doctors to write you a letter for one unless you have a legit medical reason. 

[Enthusi]

2 hours ago, Kawaharu said:

It's why every time I go see them, they always run a diaper check on me and make sure I am using them properly.

What do you mean?  How does one improperly use a diaper? 
 

2 hours ago, Kawaharu said:

 

I disagree because unless you have a VALID medical reason for a doctor to write you diapers on your medical record, your on your own on this one.

 

My doctor knows I wear diapers. I saw a urologist in the past (see above) and “Mixed urinary incontinence” is on my chart. So I can check that off my list.  

[oznl]

There is a scheme in Australia to subsidise (not outright pay for) incontinence products for those with a specific range of diagnosis.  Like many of these Government schemes, its value has been allowed to wither in the face of decades of inflation to the point where it would no more than take the edge off the cost of full time nappies.

Would I attempt to use it?

For emulated incontinence, the answer is a swift “absolutely not”.  Along the lines of @FretaBWet and @cathdiap, I would regard it as a fraud against taxpayers and effectively theft from those with legitimate need.

IF I was to acquire some physiological incontinence it gets more complicated and my answer is more nuanced.

I STILL would most likely not attempt to use this scheme.  Not at least whilst I had my own means and mental capacity to take care of those needs.  My principle here would be that I’d made my bed and should lie in it. 

That’s my personal choice but I’m not 100% convinced that it should apply to others.  Holding people accountable for negative health outcomes that they could have avoided is a bit of a slippery moral slope.

[meeko313]

also an american here. i think this is a great question! can spark an interesting discussion, and i do think perspectives would vary greatly from country to country.

personally, I wouldn't have any qualms about getting diapers covered even having intentionally untrained. I agree that it is essentially having taxpayers pay for my fetish, however, I'm a taxpayer too. and my taxes pay for a LOT of other things i don't agree with. so it goes both ways, i think. it's not just me using taxes to indulge myself while giving nothing back, so i have no problem using the system in exchange. if, hypothetically, my country operated much more in line with my own views, and i felt all of my taxes were well-spent, i probably would think it's wrong to take advantage of the system in this way. but that's far from the case unfortunately. I guess inherently i think it's wrong, but i'd do it out of spite.

to follow up on some replies, i don't really believe self-induced incontinence is valid. I don't believe there's such a thing as a psychological need to be incontinent. i feel like that's just kinda an image some people present to try to escape needlessly cruel judgement for their interests. but it certainly shouldn't be regarded as the same as an actual medical condition.

but yeah! there's my 2 scents~
*flickers my fluffy skunk tail teasingly 'cause i'm a total furry*

[deewet]

When did the US start to pay for medical insurance from the tax rolls?  I suppose you could say that Medicade is tax paid assistance, but correct me if I am wrong, but don't the states pay for most of that?  That would fit the bill for sure but not as a "USA pd benefit per say.  

When it comes to Medicare, that was sold to people like social security was, you pay into a system all your working life, and when you retire you draw out of it and still pay a portion even then. 

Unfortunately, Medicare and Social Security are very poorly managed, have money used for many things not intended for originally, and are going to run out of primary funds very soon. 

Worse than that, Medicare is very poor insurance coverage IE when I left my company which was self-insured, my copay for medical, dental, pharma, and vision was less that what my Medicare and supplement is now, and I had no restrictions on which doctors I could see, and the doctors were all getting paid much more than what they get pd now on our govt managed insurance!

[meeko313]

8 hours ago, deewet said:

When did the US start to pay for medical insurance from the tax rolls?  I suppose you could say that Medicade is tax paid assistance, but correct me if I am wrong, but don't the states pay for most of that?  That would fit the bill for sure but not as a "USA pd benefit per say.  

When it comes to Medicare, that was sold to people like social security was, you pay into a system all your working life, and when you retire you draw out of it and still pay a portion even then. 

Unfortunately, Medicare and Social Security are very poorly managed, have money used for many things not intended for originally, and are going to run out of primary funds very soon. 

Worse than that, Medicare is very poor insurance coverage IE when I left my company which was self-insured, my copay for medical, dental, pharma, and vision was less that what my Medicare and supplement is now, and I had no restrictions on which doctors I could see, and the doctors were all getting paid much more than what they get pd now on our govt managed insurance!

where do you think the "state's" money comes from? all government spending comes from taxes in one way or another. 

[FretaBWet]

@deewetMedicaid is funded jointly by the federal government and the states. All the funds come directly from state and federal taxes.

Medicare is funded by taxes but only from the social security tax which is deducted from the employee and matched by the employer. So all the Medicare costs are shared by those receiving Medicare and the employers they worked for.

When you compare Medicare to the health insurance provided by your employer you're comparing apples to oranges and that is not a fair comparison. The money your company spends to fund it's self insurance plan is coming from the money it makes from it's business. In a bad economy your company could change the plan to lower it's cost. It can also choose to raise prices to keep the plan funded or change what is covered. It has choices as to how to deal with higher costs. Medicare and Medicaid are set by law. States and the federal government have no choice, they must follow whatever the federal and state legislatures enact into law.

Hugs,

Freta

[Cruiser 03]

I have never had to ask, as the doctors have always provided it along with a prescription it’s just part of doing the paper work .

[stevewet]

Here in the UK once you are diagnosed as incontinent or enuretic. You are referee to the NHS continence service. They assess your needs and you get regular supplies sent via the NHS supply chain. My medical notes clearly state I am incontinent and enuretic.

[cathdiap]

22 minutes ago, stevewet said:

Here in the UK once you are diagnosed as incontinent or enuretic. You are referee to the NHS continence service. They assess your needs and you get regular supplies sent via the NHS supply chain. My medical notes clearly state I am incontinent and enuretic.

Are your supplies limited to a certain amount of diapers per day? In the Netherlands, as an incontinence patient you are entitled to a reimbursement for five incontinence products per day.

[deewet]

I have to step up again in this conversation, as there is a bit of uninformed rhetoric going on here.

As I said, Medicade is supported by taxes, mostly by state taxes I will add- check it out if you doubt me, the states pay for the greatest share of Medicade and as a result, rules about who can get what from this program differ from state to state.

Medicare is NOT funded by social security, it is a program by itself and collects funds as a separate item from employers and employees, much like social security but within its own program. (check your pay stub, you will see deductions for social security as well as medicare)  As of today, it is self sustaining (Ie no federal tax support) but that is short lived, same as social security as each program is headed to insolvency.

To say that employer provided health plans were not far superior to what we have with Medicare is certainly not accurate, I worked for 50 yrs prior to retirement, in the beginning I purchased my own health insurance, but following 4 decades, it was employer provided.  The last 20 yrs I had the best coverage I ever had, including great dental and vision, as well as pharma with no restrictions.  This was with a company that employed only about 70,000 people but they pursued good health practices, promoting healthy activities, even paying for many of the extra things we can do to stay healthy.  They were self insured  (their trust partners that facilitated the program)  paid doctors and hospitals typically in the 70-90% range of billing compared to what Medicare does, which is less than 30% of what they call covered expenses (I check my medical billings, you should as well)  How long can our health system survive getting paid such a small portion of what they bill.  Could you live today if your pay checks were only 1/3rd of what you anticipate?  Why do you think that most doctors will not take new patients on Medicare, only patients they have a history with prior to getting on Medicare.

I have traveled the world in my working life and witnessed first hand what socialized medicine has done in other countries, and can see that we are certainly on a path in that direction.  I hope we will remember what we are about to give up!!!

[meeko313]

1 hour ago, deewet said:

I have to step up again in this conversation, as there is a bit of uninformed rhetoric going on here.

As I said, Medicade is supported by taxes, mostly by state taxes I will add- check it out if you doubt me, the states pay for the greatest share of Medicade and as a result, rules about who can get what from this program differ from state to state.

Medicare is NOT funded by social security, it is a program by itself and collects funds as a separate item from employers and employees, much like social security but within its own program. (check your pay stub, you will see deductions for social security as well as medicare)  As of today, it is self sustaining (Ie no federal tax support) but that is short lived, same as social security as each program is headed to insolvency.

To say that employer provided health plans were not far superior to what we have with Medicare is certainly not accurate, I worked for 50 yrs prior to retirement, in the beginning I purchased my own health insurance, but following 4 decades, it was employer provided.  The last 20 yrs I had the best coverage I ever had, including great dental and vision, as well as pharma with no restrictions.  This was with a company that employed only about 70,000 people but they pursued good health practices, promoting healthy activities, even paying for many of the extra things we can do to stay healthy.  They were self insured  (their trust partners that facilitated the program)  paid doctors and hospitals typically in the 70-90% range of billing compared to what Medicare does, which is less than 30% of what they call covered expenses (I check my medical billings, you should as well)  How long can our health system survive getting paid such a small portion of what they bill.  Could you live today if your pay checks were only 1/3rd of what you anticipate?  Why do you think that most doctors will not take new patients on Medicare, only patients they have a history with prior to getting on Medicare.

I have traveled the world in my working life and witnessed first hand what socialized medicine has done in other countries, and can see that we are certainly on a path in that direction.  I hope we will remember what we are about to give up!!!

i don't even know where to begin with this reply. really don't think this is the thread for your weird political rants dude. the discussion isn't about private insurance vs assistance. it's about whether or not one should get assistance for self-induced incontinence. what specific department that TAX-FUNDED assistance comes from is irrelevant. you're confused and derailing everything. stoooooooooooooop.

[Cruiser 03]

In my state the Cadillac of approved diapers is the ATN and my limit because I add boosters is 3 cases of ATN 1 case of top liner boosters. my entire routine monthly supply is:

3 cases of ATN

1 case top liner

1 case bed pads 

2  boxes gloves

150 catheters

2 overnight drainage bags

 

 

[maxabdl@me.com]

On 10/13/2022 at 6:20 PM, oznl said:

There is a scheme in Australia to subsidise (not outright pay for) incontinence products for those with a specific range of diagnosis.  Like many of these Government schemes, its value has been allowed to wither in the face of decades of inflation to the point where it would no more than take the edge off the cost of full time nappies.

 

Yeah that's true about that one, it's not enough for almost one month of supplies. But there are two schemes in Australia that can help with incontinence, one is a standard one that you can get on to with minimal effort... that is the one you are referring to. But then there is also the government's National Disability Insurance Scheme (NDIS) which if you have a savare lifelong physical or mental disability you can get funding for all sorts of medical supplies and supports. (Just having incontinence is not considered severe enough)

I am on the NDIS and I have my nappies fully funded by them. But that is a small cost compared to my other supports funded by them. One of the reasonable parts of it is that i also get to choose my nappies and get the product that is right for me. That way I'm not stuck with sub par nappies.

You have to go through alot to get onto the NDIS and get funding approved. It is very strict on who can get approved.