Who Pays for Ostomy Supplies

You Want to Know Who Pays For Ostomy Supplies

Having an ostomy requires ostomy supplies. So naturally, the question who pays for ostomy supplies comes up.

So back a few years ago when I was waiting to get discharged from the hospital I realized that I wasn’t really sure how much I was going to be paying for the ostomy supplies I had to have from then onward.

Or maybe I wouldn’t have to pay for the ostomy supplies?

Well, I figured that we had better find out who pays, and who pays how much if it is a split responsibility.

My First Exploratory Steps To Deciding the Products For Me

So when I arrived home, I first relaxed and I have to tell you openly I was very happy to be home. I am sure you would have been as happy as I was.

As things settled in, by the next few days, I had a visit from my home care nurse and I realized that I needed to investigate other supply companies and what they had available.

The nurse talked to me about what other patients used and things that they have done that helped them out. We talked about the types of bags and wafers. Especially the bags there is an enormous amount of selection to choose from.

She even gave me a few company samples to see and use. That would then help me out in figuring out what would work for me. What I was comfortable using, as I would be the one dealing with and using the equipment.

Determining the Cost: the Steps to Take

During my first few weeks the equipment I was using was some ostomy bags and wafers the hospital nurses gave me when I was being discharged.

At that time I was paying little attention to the whole thing. I just wanted to get home after 6 days in the hospital.

Now I was paying attention. I decided from my sample examples what worked for me, (at that time), I say at that time because things will change for you, the more experienced you are, and the more you see what your needs are.

I called a supply company that was recommended by my colo-rectal surgeon’s office. We got an account set up, and I found out what my co-pay would be on each order.

Now that part was done. I now had an idea what my per month cost was going to be as I planned out when I was going to change everything, and then how long my supply would last for me.

Where the Payment Responsibility Lies

Your order will usually arrive at your home within a week. Once It does you will have an invoiced cost, and then I checked in week number two with my account with my supplier online.

Usually by the 8 to 14 days after your order has been shipped and processed with your insurance then you will be billed by your supply company for the part of the order the insurance company did not cover.

That then will be your cost and your responsibility. So that is how it works for me. It may work differently for you as everyone’s insurance situation will probably not be the same.

So there will be some payment that you personally will need to pay for. They are treated under insurance programs as what is determined to be a medical device.

Since I am now on government mandated (because of my age) Medicare, I know that Medicare covers these supplies as prosthetic devices.

Difference Between a Prosthetic Device and a Medical Device

So a Prosthetic Device is defined the following way: “Referring to a prosthesis, an artificial substitute or replacement of a part of the body such as a tooth, eye, a facial bone, the palate, a hip, a knee or another joint, the leg, an arm, etc. A prosthesis is designed for functional or cosmetic reasons or both”

So as you can see an ostomy is an addition to my body that now serves the purpose of a normal body function. This body function used to be that my normal functions are the same for well over 99% of the population, but having an ostomy puts me in with a very small minority.

Probably one in a hundred thousand people will actually have an ostomy

For more information, if you are coming up on 65 years of age and Medicare you may go to the Medicare page for what and how ostomy supplies are covered by going to this page, CLICK now for Medicare.gov.

So is an ostomy bag and the wafer that is part of it considered a medical device? Great question.

Actually the FDA the federal Drug Administration has deemed an ostomy bag a medical device. See this page for this description, go HERE NOW for the FDA Description.

All of this to say with each insurance company they may have your ostomy supplies list as either covered or not covered and the percentage of coverage will no doubt be set up according to how they list these supplies under your present medical insurance policy.

Ostomy Supplies and Choices

So it’s in your court as you can see. It is up to you how you wish to keep your ostomy in operation. What type of bags do you choose to use? Here are a few of the choices. Some are more economical than others.

There are a couple of Ostomy supplies companies that will give you some choices in name brand products that you trust for quality ostomy supplies. They are Convatec and Coloplast. I personally use products manufactured by Hollister. That is so because I was exposed to products that matched my need.

You may also like to take a look at a few of my suggestions. They are three of my favorites and the good that I found in them.

These three are all from the manufacturer Hollister. These are from the product lines that I personally use and have extensive experience with.

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An Overcomer

George writes from first-hand experience about having a stoma and living with an ostomy. As a former cancer patient and a survivor of colon cancer, you can draw from his experiences. His goal is to help you as he shares the realities of living with an ostomy.