Insurance Limits on Bag Changes - Discussing Options

Hi, why does insurance only cover 20 bag changes per month. 

What if I wanted to change mine every other day instead of every 3 days? 

Does anyone else get more than 20 a month? 

Do you have Medicare or private insurance?

I've had both.  Private insurance, from my employer, was far more generous than Medicare.  But I paid much more for private insurance.  Medicare has to balance care, with available public funding.  

While I was still working, I bought several months worth of spare ostomy supplies on Amazon as back up surplus, knowing eventually I would be on Medicare.

Thank you. I have private insurance but also pay for medical assistance (medical assistance for workers with disabilities) which I pay for monthly to cover all the copays and balances for medical things. 

Hi there, yes, it's standard with insurance companies to get 20 bags a month. There is a loophole you can have your doctor put for 30 bags a month. Why do they do it? It's stupid. The only thing I had figured was they assume that every ostomate changes the bag every 3-4 days, so to them, only 30 is needed, but that's not the reality for all ostomates.

Ok good. Thank you. I sent an order for 20 but I will call the insurance myself and ask for 30. I really prefer to change this daily. I get it that my skin might tear easier because of taking the barriers on and off. I feel like I'm either going to break down from output or from barriers. 

How to Manage Ostomy Leaks with LeeAnne Hayden | Hollister

My insurance will pay for up to 40 a month, but I don't usually order that many; 20 a month is plenty for me.

Hi... um, when you say you prefer to replace your appliance daily, you do realize you can wear the appliance longer? And you also mentioned skin might tear. It doesn't tear. It becomes irritated, red. Eventually, it may develop sores or openings like mine did... and... bleed.

Mine was a reaction to a barrier ring. I needed topical medication to heal it, and in my case, it was my fault this happened. Can you imagine your appliance not sticking because of irritated skin? That was my case 2 weeks ago. Ugh!

So just keep in mind redness is the first sign of irritation. Don't take it lightly. And you may want to keep the appliance on another day or two to prevent that.

I honestly never heard of skin tearing unless you're using gorilla glue - I can see that happening.

You will be alright for an additional day or two. Inspection of your flange daily will show any seepage or leak. Use a mirror to see under the flange. That is the most likely place it will discolor. The sides too. Once in the morning, once before bedtime is a good practice. 👍

20 per month is for drainable. If you go with closed pouches, since you wanna change daily, the allotment per month should be more. I would guess the standard 20/month is to prevent a person from getting a higher amount and then selling the surplus. 

I would prefer to change it more often. 

Skin tears can happen from many different things. Gorilla glue is not necessary.

When the skin is pulled in one direction while the underlying tissues are pulled in another 

Other causes of skin tears include: Poor handling, Equipment injury, Removing adhesive dressings, and Trauma from jewelry or nails.

I appreciate your input 

 

 

Are you leaking, and is that why you want to change it every day? Changing your appliance every day, unless needed, can also break down your skin. It's very sensitive. And your doctor has to put the request in with your insurance company; you can't do it yourself.

I feel dirty, that's all. I'm more afraid of skin breakdown due to output. I just wanted to confirm with my insurance that they only cover 20 a month. 

Are you using a 1 or 2 piece system? If using a 1 piece system, perhaps a 2 piece system would suit you better? Then you could change the bags daily without risking skin injury. You could thoroughly clean between bag changes and that might help you tolerate it a day or so longer. 

I can get 60 closed end bags and 20 wafers a month for my colostomy but only 20 open end bags and wafers for my urostomy.  I believe the limit on open ended bags holds regardless of ostomy type.