Medicare's Limitations on Ostomy Pouches - Seeking Solutions

This question is for ostomates in the US on Medicare using 2-piece systems with sealed pouches. As you know, Medicare will only cover 2 pouches a day (box of 60 pouches for a month). I am very short, 5'2", and use the 7" mini sealed pouches. I average 3-4 a day, not 2. I have tried the resealable pouches to extend their length of use, and it was a nightmare! My output is very firm, and emptying into the toilet causes splash-back, gets poop all over my hands and the end of the pouch, and doesn't want to come out of the pouch at all unless I squeeze it out, with resulting residue everywhere, including still in the pouch (which then sticks together and no new output wants to actually go into the pouch, leading to pancaking...). A real mess. I tried the 9" regular bags, but I am so short, they run down into my pants leg when wearing pants, and below my crotch when wearing a skirt. With it only 1/4 full, it's long enough that it starts swinging like a cow's udder, becoming very uncomfortable and visually extremely strange-looking as it swings against my clothing. It makes me feel less of a person - and you know what happens when your self-image starts eroding. I found the solution with the 7" mini sealed pouches - I live my life with no real problems and minimal disruption.

When I had private insurance, they covered however many I needed, as long as they got confirmation from my doctor that they were needed. Medicare, however, says that I can live my life with 2 a day. I say I cannot (because filling the stupid pouch until it bursts is a stupid way to live your life). Who out there has experience with Medicare and sealed pouches? Any other solutions that maybe I haven't thought of? I cannot deal with irrigation; just can't handle it. Any other suggestions? Any way around Medicare's limitations?

I have occasionally bought extra supplies online, but that is running anywhere from 80-100 a box. Still looking for other answers. Thanks.

Newbie Dana.. Medicare is my secondary, however they still dominate other insurances. I get 20 pouches a month and that's definitely not enough, I use a two pc sealed pouch too. When you change the barrier try putting baby oil in the hole of the pouch. It tends to help the poop slide down, thus you wouldn't have to do all that work. I wish I knew how to change the system, we could send letters, but it would take many. Girl, seems like they would have to walk in our shoes before it actually mattered to them. I too have purchased pouches on the outside and it's quite expensive. I do irrigate, however I have yet to achieve 24 hours of freedom. Some use caps during the day, for my sanity and safety I use pouches. Perhaps someone will chime in and have an answer for those of us who need one.

Take care

Angelicamarie

Couple things that will really help you get comfortable and have more success!

I wear an Ostomy Secrets classic wrap to support my bag. Large, small, doesn't matter, I wear this 24/7 and doing so has been life changing. I also use Ostomy Armor Waste Wicks for blowout/leak absorption. Since I started using them, my mess problems have gone to virtually zero. Wearing the support wrap has made all the difference in my life. It helps conceal the bag, it supports the larger bag so I can go longer between service stops, I do not worry about its weight when partly full or even nearly completely full. Discovering them has been a life changer for me.

I am 5' 10" and cannot sit on the toilet. Twice I've broken open my Barbie butt doing so. I currently use 9-inch resealable pouches and have what my doctor calls a high output stoma. So instead, I used a plastic container, mine is triangular in shape from a medical device store, holds about 1.5 quarts. I place it on the countertop in the bathroom, empty my bag into the container, and then pour the contents into the toilet. You can wear gloves while doing so, but I've found this method to be pretty darn clean.

If my output is sticky or solid, I'll use a squeeze bottle and squirt some water into the bag, close it up, squoooosh it around, and then empty into the container. When I am done, I put everything back under the sink and wash my hands. Someone above suggested cooking oil, which is a fine idea as well.

Good luck, I hope some of this helps.

Maybe get drainable pouches instead. Insurance may cover less, but it is possible to clean and reuse.

Hollister makes a drainable mini pouch 18283, there are 20 in a box. I'm only 5 ft tall, so I know what you're talking about. A full pouch hangs down my leg.

You can use one of those cheap sprayers that push on the sink tap or whatever tap you use to spray out the excess poop. Then roll up the bottom and you're good to go until the next poo time...

I have reused a pouch by just cleaning it and drying it. Nothing worse than being out before your next order can be called in. Plus, in my day, we washed cloth diapers and reused them weekly. And a pouch really does not touch the skin like a baby diaper... Whatever works for each person certainly must be okay. Good luck.

Words of Encouragement from Ostomy Advocates I Hollister

When I was out on high dose Imodium, I ran into the problem of my output being too thick as well. Now, I always open the top a little and add water, swish, then empty. It puts an end to splash back. A few drops of oil each change helps as well, or the deodorizer that lubricates.

Well, this concerns me because I'm retiring soon (two weeks) and will be on Medicare as well. I will have a secondary insurance, so I hope what Medicare doesn't cover, my other one will. But now I'm nervous from what you are saying. How dare they say how many you can use and "get by" on. People are different. I bet I pee more than most normal people due to my cancer surgery, so will they tell me I can only wear incontinence liners once a week or something? That's BS! That's like the insurance companies overriding your doctor's prescriptions, saying "you don't need those". It infuriates me!

Anyway, I use the two-piece appliance as well and prefer them much more over a one-piece that you have to drain. My only suggestion would be to take some anti-diarrhea to slow you down. If my output is too soft or often, I will take TWO anti-diarrhea pills (Walmart brand), then usually one daily just to keep it more normal. This way, I don't have to change my pouch as often. "Input" always equals "output", so keep that in mind, too.

You might also want to see if a letter from your doctor explaining why you need to change more often than normal and send it to Medicare. It's a long shot, but worth a try.

If you can afford it, you should maybe look into a secondary insurance to cover what Medicare doesn't. That sucks. :(

There's no way in heck am I going to "rinse out" a pouch. I can't even begin to imagine the mess!! It's why I'm so glad I found the two-piece. No rinsing or reusing. Just detach, and toss. NO MESS! :)

Hi,

A similar situation has been happening to me all year. I happened to have developed a parastomal hernia and I have been using a two-piece closed-end bag. I'm on Medicare (ugh), because of the hernia the wafer would not adhere totally and I would get leakage. Sometimes I'd have to change the wafer 3 times a day even with using a skin prep and tape. I called my doctor, they got in touch with my supply company who then was in touch with Medicare. They sent me early supplies because of the medical need. It's time to put in my regular order. I'll call tomorrow, I'm not anticipating a problem. Have you spoken to your doctor? He may be able to help. Have you tried folding a larger bag and using Coloplast's Brava Lubricating Deodorant? You put three drops in the bag and output slides down, Medicare will pay for it. Good luck, I feel your pain.

My best,

Sara

Hi, I get it. My insurance wanted to give me 20 pouches a month. They obviously were never ostomy patients. I get a letter of necessity from my primary physician, which entitles me to 40 a month. I use Coloplast 2-piece with Velcro closing. I have my ostomy on the left, but I angle my pouch to the right. This means it does not hang straight down. I also coat the bar and pouch with a smear of Vaseline, which helps everything slide. Not too much angle as you need a bit of gravity. I also close the vent and burp when needed, otherwise the vacuum is too much and I get pancaking. Hope this helps.

You need to see an ostomy nurse or enterostomal therapist to determine the reason your pouches keep coming off. You should get at least three days wear per pouch under normal circumstances.

I found this online about what Medicare covers for ostomy supplies:

*********
Covers the amount of medically necessary ostomy supplies your doctor says you need. The amount is based on your condition. Medicare covers these supplies as prosthetic devices. People with Medicare Part B who've had a colostomy, ileostomy, or urinary ostomy are covered.

Maybe your doctor needs to change the amount you need. My doctor approves everything and anything I need or want :) But this was pre-Medicare, so I'm hoping nothing changes. I'd contact your doctor if you haven't already. Also, where do you get your supplies from?

Okay, I just got off the phone with Medicare. They do only approve 60 pouches per month, but your doctor can contact them, via phone, online, or however they are set up with Medicare, and justify why you need extra pouches. Then you should be okay.

ColoMajic Ostomy bag liners. I believe that they will even send you a sample or two. I've been using them for years and I really like them. One sealed bag lasts me about ten days. Of course, my wafer doesn't usually last that long, but one bag a week has been what I use now.

https://colomajic.com/testimonials/

Do you have secondary insurance? It may be worth looking into.... Also, see if you can appeal through your state insurance commissioner.

I am also 5-2 and I use a one-piece drainable pouch. Hollister 8331. By placing a strip of toilet paper in the stool, it will help cut down on the splashing. Also, my ET nurse told me to use a stool softener 2x a day, which can be purchased at Walmart for 4 dollars. I use it now once a day. I also use water in my pouch each time I empty it. I fill a graduated medical pitcher and use the water to flush my pouch each time. It has worked very well for me. Also, when out, I carry a bottle of water with me and use that if I need to empty. I keep it in my purse. A small bottle is all I need, and it can be refilled from any tap. I go 5 to 6 days between changes.

I use open-ended pouches, a 2-piece system. Natura. The bag is 8". When I couple it together, I put a drop of oil on the plastic circle so I can easily slide the bag to the right or left under my clothes. I wear underwear over it. If you wear dresses/skirts, wear a band or pouch cover if you don't tuck it in your underwear. At night, I use a high-output pouch.

To prevent splashing in the toilet: A. One piece of Kleenex in the toilet. or B. Get a package of toilet seat covers and use the cover inside the toilet. Works great. At home, I use 1/3 of a cover. Does the trick.

Cleaning an open-end pouch: 1- drain the pouch. 2- wipe the end clean. 3- wrap a piece of toilet paper about 4 pieces long around your index finger and wipe inside the bag. You won't get your hands messy.

Keep experimenting until you find what works for you. You can do it.

I also have Medicare now. They do limit the number of bags. Secondary insurance will only grant the Medicare maximum- unfortunately. I have found with this system, I just wipe the end as I've stated above and set it aside in a plastic bag for the next day. I don't wash them. If there is a bit of leftover stool clinging to the sides of the bag, it does not bother me.

Liners are the way to go for those, like me, who are on Medicare and only allow for 60 pouches per month. That's two bags per day! What a crock! So to save on pouches, do the liners! I have a two-piece disposable appliance, and believe it or not, made my own liner using the produce bags from the supermarket! LOL! I just cut to size, used a flexible 12" ruler to tuck it down to the bottom, and out to the sides, then cut the top where it meets the opening that snaps onto the flange. Worked just fine! But you can also order some liners from your supplier if your insurance will cover it (they should). Just wanted to share this for those that need to stretch their pouch supplies. At least until you can get enough supplies on hand until you are ahead of their ridiculous schedule to order again. :)

I'm only 5' and I wear Hollister 1" Premiere Drainable Pouch #8612

Flextend Convex 5 per box. I've had my colostomy for 40+ years now

I change the bag 2-3 times a week

My Medicare and secondary insurance cover all

Hello,

Do you know about liners? Colo-Majic makes liners to fit inside your pouch. They are flushable in all systems except septic tanks. I also use a two-piece pouching system. I have finally stockpiled by using eBay. When on eBay, you really have to search because there are stores set up by people wanting to help by selling things cheap. Hope this helps.