Insurance for Ostomy Belts - A Personal Struggle

I just discovered Medicare doesn't cover ostomy belts, but I have secondary insurance that does cover belts.

However, my ostomy medical product supplier won't order the Nu-Hope belts I want because Medicare doesn't cover them. I explained to them: Medicare will deny, then my secondary insurance will pay. Two months ago, they claimed they ordered the belts. I called Nu-Hope today. They haven't received any orders from my supplier for me. Grrrrrr.

Nu-Hope said they sell a new 2-inch wide belt on their website. I ordered 3. Nu-Hope also told me of a retail website that had the full line of Nu-Hope belts. I went there and ordered 2: a 3-inch and a 4-inch wide belt. So, even though I have expensive insurance, I still have to pay out of pocket for belts. If you would like more info about the retail ostomy site, email me.

Hi BB,

I'll say right up front I don't know squat about Medicare, but I Googled "Does Medicare cover ostomy belts in 2024" and every site that popped up said they did. AI added the following:

Medicare Part B (Medical Insurance) covers ostomy supplies as prosthetic devices for people who have had a colostomy, ileostomy, or urinary ostomy. This includes ostomy belts, but you should contact your insurance company to confirm and request reimbursement. Medicare covers the amount of supplies your doctor says you need, based on your condition. Medicare pays 80% of the Medicare-approved amount, and you pay the remaining 20% after reaching your Part B deductible, which is $240 in 2024. You may pay less if you have supplemental insurance, such as Medicaid or a Medigap policy.

Not saying you're wrong, but I couldn't find one site that said Medicare wouldn't at least partially (80%) cover the cost of ostomy belts, assuming your doctor says you need one... not even one site. That seems a bit odd. Since you know first-hand... what are all these sites missing?

;O)

I called Medicare a couple of times. Called my secondary insurance. I have a prescription from my surgeon for hernia support belts. I've been trying since April to get belts from Edgepark. I've ordered them multiple times, then waited... and waited. Called Edgepark and they said Medicare doesn't cover belts. Called Nu-Hope today, they have no record of belt orders for me from Edgepark. So... I don't know. All I do know is this: I just paid $200 for belts. Tired of waiting.

Ahh... I think I see the issue. You initially said 'ostomy belts', not 'hernia support belts'... big difference. Not really, but Medicare seems to think so. Medicare will cover a hernia support belt if it meets their definition of a 'brace'... which is defined as:

"The Centers for Medicare & Medicaid Services (CMS) defines a brace as a rigid or semi-rigid device that supports a weak or deformed body part, or limits or eliminates movement in an injured or diseased body part. In November 2023, CMS expanded the definition to include powered exoskeletons and orthoses, which are devices that stabilize, position, support, and restore the function of weak limbs."

And a belt, which isn't rigid or semi-rigid, doesn't qualify. So you, my friend, are getting screwed by a technicality! You might want to see if your doctor can prescribe the belt you want specifically for your ostomy, and not for your hernia. It's stupid, I know... but when in Rome... fight fire with fire... or something like that. Maybe that was a Bugs Bunny cartoon... oh well... I'm rambling. You know what I mean.

;O)

I have at least 2 Nu-hope hernia belts - is that what you are referring to? Medicare pays (not sure what portion - will need to look it up) and my supplier tries to send them once every so many months. They are not comfortable and (so far) I don't wear them. I do not have any "backup" insurance. I tell the supplier I don't want them in my order. jb

Words of Encouragement from Ostomy Advocates I Hollister

The Nu-Hope belts I want cost less than $50 each. They last me a long time. Yesterday I decided, "screw it," I'll just buy them. The Parthenon website has them. I also called Nu-Hope and discovered they have a limited amount of belts available on their website; those belts are $30 each. I'll avoid restaurants and eat at home for a week, and that will pay for the belts.

I have original Medicare, Medigap G supplement insurance, and Anthem BCBS secondary insurance. Anthem said they would pay for the belts after Medicare denies my claim. But Edgepark won't order my belts, saying Medicare doesn't cover them. I've been doing this circular dance since April.

Thanks, w30bob - saved me a trip to the file cabinet... one less chore for today... think I will use the extra time to write “waiting with bated breath replies” to some posts on the website... 🤪🫦jb

I haven't tried ordering a "hernia" belt since going to Medicare, but I just looked at Edgepark's offerings of Nu-Hope belts and each one shows me that Medicare will pay 100%. Whether or not that is true come checkout, I haven't tried. They have both my Part B and Medigap policies on file. I also don't know if they would actually follow through on delivery. I've had problems getting the standard Adapt support belt from them in the past. They ended up finally sending me inferior CardinalHealth belts instead.

Daniel

I also had struggles getting supplies after my surgery. I would say Edgepark was probably the worst experience so far. I never received any supplies from them. They would say my insurance denied it, and I called my insurance, and I was covered. Wasted too much time with Edgepark. The current DME supplier isn't without problems. I don't think they read anything from the doctor's office because they still send me the wrong size bag even after following up with them to make sure the changes were made. So many skin issues and problems with bags not fitting/sticking. I hope you've managed to get what you need.

Actually, my written prescription is for an ostomy belt. My ostomy supplier has a copy of the prescription, and I made Medicare aware of it. But since April, no belts have been ordered from Nu-Hope on my behalf. My secondary insurance is ready to pay as soon as Medicare denies my claim. But my ostomy supplier won't order the belts, even though they tell me they did. Nu-Hope says they didn't. I also have a Medigap insurance, Plan G, that pays what Medicare doesn't. All this insurance, which costs me over $1100 a month, and I can't get a $50 belt. What's funny is I would pay anyway due to the deductibles. So, I ordered $200 in belts and paid for them myself. I got the first shipment today from Nu-Hope. I feel badly for folks struggling with inflation, who cannot afford to pay for belts or supplies.

You know, I'm not sure what to think. Last year, I ordered Nu-Hope belts; they arrived with no problem. But, I was under regular medical insurance from my work. Since I've transitioned to Medicare as the primary payer, and Anthem BCBS as secondary, I ordered the exact same belts and quantities... and got nothing. Three or four times, (I've lost track), I called them about the missing belts. They had me reorder them all over again, use my credit card to guarantee payment... then nothing. That's why this time I called Nu-Hope directly. They had no record of any belt orders for me. To be fair, all my other supplies arrive as scheduled and it's all exactly what I ordered. So, I'm just going to buy the belts when I need new ones.

That's odd. I have Medicare and supplementary insurance. I'm in Florida, so I don't know if coverage differs from California. The way it works for me is if Medicare covers it, they will pay 80%. If Medicare covers it, my supplementary insurance pays the balance of 20%. If Medicare doesn't cover it, my supplementary insurance doesn't cover it either. However, I have recently also run into a problem with Nu Hope belts. I get my supplies through Edgepark, and they informed me they no longer supply the Nu Hope belts, but I can get a different manufacturer's belt that they supply and it will be 100% covered. My question is, is it a problem with your provider?

Try contacting your provider's customer service to see why this is happening. You might also try ordering a different belt. I was having a problem with Edgepark, but I had no problem with Byram.

You might consider switching to Byram, which seems to order Nu-Hope support belts with zero hassles for others as well as myself. Between Medicare and your insurance, these are covered 100%.

As I reached my out-of-pocket expenses, I got free 2" belts from Hollister. Hate them! I use Stealth belts and love them. Some people prefer their wrap, easy on and off. As a hiker and active senior, the standard one works for me. It supports my weak abdomen and stoma. They have a model for dress-up and can customize one for hernias. This belt will hold back any leaks, too. About $110-130.