Medicare Coverage Changes Affecting Ostomy Supplies

I've had my ileostomy for 24 years now, so I pretty much know what works on my body and what doesn't. Two months ago, when I tried to order the Cavilon No Sting Barrier Film, I was told Medicare no longer covered it and I'd have to pay for it myself. Oh, I did receive a free sample of the new Medicare-approved product to try, which didn't work on my skin at all. So, today, when I'm trying to order one of the Bard Wipes I've used for 24 years, I'm told the same thing! Medicare won't cover it. I asked the person if these people who invent these new products have colostomies or ileostomies and she told me no, of course not. How dare they try to interfere with our delicate skin areas and the products that we know work so well? It's just unbelievable to me. Has this happened to others on Medicare?

Perhaps the person taking your order is wrong about the coverage. I know that the "Obamacare" law is going to change just about every aspect of healthcare as we know it. I'm not sure anyone knows exactly what's in the law, and some unpleasant terms are timed to take place months and years down the road so those responsible for it can deny they had anything to do with it. I suggest you call or, better yet, visit your congressman's local office and ask them to explain any changes to you. I would be interested to hear what you find out.

Hi Joanmarie,

President Obama took $700 billion out of Medicare to help finance the ACA, so all of us seniors can expect to feel the consequences of this ill-crafted legislation sooner than later. My wife and I have been notified that certain drugs we have been taking for years, even generics, are no longer on the Medicare formulary and we must do without them.

MMSH gave you good advice. I will just add this suggestion. Have your MD write a letter to Medicare indicating that the Cavilon film is the only effective product to meet your special need and that other products would create hardships. My doctor's appeal letter gave me a one-year extension on a drug. The old saying about the squeaking wheel getting the oil applies. Make some noise. Good luck, and let's keep those politicians out of our medicine cabinets and ostomy supply drawers.

   PB

Hi Joanmarie.

I too was told last time I ordered my supplies that my insurance did not cover the 3M Cavilon barrier wipes. They told me to try these from Convatec. Well, I am very upset. A few reasons. One, why after 5 years did they decide to do this? Second, the Convatec really stink. It did not allow my barrier to adhere to my skin. Third, I also pay over $200 on supplemental insurance and I do not think they go by Medicare guidelines. I use Byram and they tried to pull this crap on me one other time. I used to get Ilesorb but one day they told me insurance does not allow it and to try a cheaper product. Well, after a year I decided to try and order the Ilesorb and guess what? Miraculously, it was covered again. So on Monday, I am calling my insurance company and finding out what is going on. I think it is just Byram trying to sell me a cheaper product that they cannot seem to get rid of. Besides, it is like 5 in a box and the 3M ones are 30 in a box. I feel if I have to pay $200 a month and my doctor gave me a script for the supplies, I should get what I want. And if my insurance gives me the runaround, I will try what MMSH suggests.

Hope this doesn't happen in the UK. I've had more comfort in the past few months after being introduced to Cavilon through this website.

Living with Your Ostomy | Hollister

I too use the Cavilon barrier wipes. They have worked very well for me for the last 4 years now. Last time I ordered some from Byram, they said that Medicare had lowered the allowable usage on these to 25 per month. (I had ordered 50). Rather than send me just 25, they waited for two months and then finally sent me 50. I'm not all that impressed with Byram Healthcare.

OMG! How lucky I am in the UK where anything I need from mattress protective covers, Cavilon sticks, spray and swabs, in fact, anything I need to bags, travel bag, wet and dry wipes, powder, and other pieces for sore skin are all free on a medical exemption certificate. I even get my medicines free even if it has nothing to do with my ileostomy. I get so angry when people who go through ileostomy or a colostomy have to pay for all their medication and bags, etc., when they have been through enough and have to live with their toilet on their belly. Why should you have to pay for anything is beyond me. The Cavilon stick is the best thing I have ever had, and also Coloplast does extensions to the bag so I never get a leak now and can keep my bag on for three days if I wish. I wish I could help, chin up my friend.

Regards

Stomafart (Jenny) x

Hi all.

What an interesting lot of information about what different countries supply to ostomates.

I wish I lived in the UK and got all those things. It sounds as though Americans are not doing as well as they used to?

Here in New Zealand, we are very limited in what we get from our Health System.

I am only "allowed" about 10 drainable pouches a month and the same amount of seals.

Cavilon, bags, wipes, plastic bags, pouch deodorants, and whatever else we need, we have to pay for.

And here, all these things are very expensive.

I know Australians are much better off than us.

Best wishes to you all. Ngaire.

Until you get it figured out, you might try getting it on eBay. I was uninsured last year and bought all my ostomy supplies there for a tiny fraction of what medical suppliers charge insurance companies.

Oh, I just got insured under Obamacare, and I happen to be ecstatic about it.
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I had difficulties that basically exploded my intestine, went through septic shock, and lost 70% of my stomach muscles. I spent 72 days in Shands along with other complications including loss of my legs. It took 2 months of therapy to try and learn how to walk again. I'm making a good comeback, but yesterday I received letters from Medicare stating they would not pay for this or that procedure. I have a plan with United Healthcare that costs $500 a month; what is really going on with the Medicare Plan? I worked for 34 years for the state of Florida without any breaks in employment, and this is what I can expect? I have friends that never worked more than a year in any job, and one guy had 2 open heart surgeries that did not cost him a dime. What should I do, live under the bridge and collect everything they have? It's called pride, and I will not do it. Well, just had to vent, Hawk

Hawk, I went through the same thing, the diverticulitis and the sepsis, but I only lost 12" of intestine. Good lord, you have been through the wringer. I'm on Obamacare for another year before Medicare, and when I hear stories like yours, I don't know if I want Medicare, but I'm sure there will be no choice.

I don't know if the link below will offer anything for you, but if not, I'd call my congressman.

https://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html

And God bless and God speed to you. Makes my heart hurt that you have had to suffer so much!

Regards,

Terri