Catheters, source, type, cost, and developments after years of use

That is the biggest frustration I have with my insurance. They will only pay for half the amount of external caths that I need. I have spoken to my urologist and insurance company and each place blame on each other. And who Is the loser me. And add insult to injury and still have out of pocket expenses. I can not waite till I am eligible for social security at 65 I am switching to AARP and hope they are better

One of our patients biggest complaints. But if you have public aide they send you 10x more than a patient needs and they get waisted. 🙁

Sometimes we find our local small DME company is more helpful then the bigger online companies. Have you checked with other providers? Have you confirmed the company is in your network?

Thanks
Dawn

Welcome @wcd97. I'm glad you've connected with @safetyshield and @dawn_giacabazi.

Dawn, Can you help my understanding? Can wcd97 stipulate which durable medical equipment (DME) company his insurance pays for? Which network?

I would be happy to explain @colleenyoung

The best practice would start with calling your insurance company and ask "Which durable medical equipment company (DME) is in my network?" Your "Network" would be, who is contracted with your insurance company. But not everyone has DME coverage which is why you should ask.

They have to provide you with a list. Usually they provide a list within a 50 mile radius but you can always ask for a smaller radius. You always have a choice to use any company so you may not know if you do not ask. You will have a larger copay if they are not in your network.

Side note: this is extremely important for patients going home with IV infusion drugs because some medications are only covered at the hospital some are only covered in home health. So doctors will change drugs or pumps to accommodate coverage. Example zosyn infusion are covered 100% with the ball pump but the cadd pump has 20% copay and would then cost $100 a day for the medication because the patient is using the cadd pump.

Hope that helps,
Dawn

We have alot of patients here that need incontinence supplies. They were paying 50% co pay. When they told us we called insurance & now they have 0 copay and the supplies are shipped to their home every month.

Some have no coverage so we get donations regularly which make it possible to provide them free from our donation closet until we are able to find a more permanent solution.

🙂
Dawn

Thanks for the extra explanation Dawn. How did a simple phone call help reduce the 50% co-pay to zero co-pay? Who does that phone call need to come from? A provider? The patient? I bet @safetyshield and @wcd97 would like to know that answer.

They did not know they were using an out of network provider. We called thier insurance and got them connected to the correct in network providers.

The patient or the doctor's office or home health or the DME company can make the call to the insurance company to clarify their list of in network providers.

Note: Most insurance companies require the Doctor to address the diagnois for the supplies in the patients visit notes or the patient needs to go see the doctor for a Face 2 Face visit before it can be covered.

Hope this helps
Dawn

I have Keiser Permantente and they are giving me a lot of problems in reference to number of supplies I get and even out of pocket expenience.I have spoken to my insurance company, doctors and suppliers and no one seems to be able get any solutions. Does anyone have any solutions?

@safetysheild
1st - Is your current provider of the supplies in your insurance network?

2nd - your diagnosis determines # of supplies but if you are using more than usual then the doctor can write and order explaining why (medical necessity) and how many items would be needed.

Lets try to help,
Dawn

I got my supplier through my present insurer and my doctors have written to both the suppliers and insurance companies and have been denied. My first insurance company Aetna and supplier(a different one that I have now) gave me my supplies I needed without a problem. For both insurances and suppliers by diagnosis has not changed. So right now I am at a lose of where to turn to now