Insurance coverage for diapers
Has anyone on this board ever applied to their medical insurance to get their diapers covered? I just asked a nurse on my insurance website to find out if they would cover them as I am spending over $3.75 a day for mine. I knew it was expensive, but didn't realize I was spending $1300.00+ a year on them!
I don't see why they wouldn't be covered, if they're used in the course of treating or addressing a documented medical condition.Originally Posted by drmmrr
If nothing else, put these into your "flex" plan so that at least you're spending PRE-tax money on them (thus lowering your adjusted gross income).
If you do have such a condition, and they won't cover them, I'd suggest taking your clothing in for dry-cleaning and billing the insurance for "clothes that I pissed all over due to nonexistent bladder protection."
Last edited by h3g3l; 04-04-2009 at 02:47 PM. Reason: PRE != POST. *sigh*
Okay, what did the nurse at your health plan say?
In the USA most health plans are reluctant to pay for disposable diapers. You need to carefully read your policy.
Previously you shared that you have a neurogenic bladder as a result of suffering a stroke. Of course all that is well documented in your medical records. What alternatives to diapers did your physicians and your health plan offer?
Although it might be fascinating to learn how other members get diapers from insurance, each policy and each medical condition are unique.
Since you spend so much on diapers every day, is there a reason you did not request diapers before?
I heard some members have prescriptions (from a doctor) so that they get free diapers. But I'm not sure if health insurance would cover them.
I guess it depends on your insurance plan.
I'll try to shed some light on this, seeing as I work in the health insurance industry (don't hate me). Basically, you will need to check the specifics of your plan, and I will say that these provisions are generally found in the outline of your policy which is generally about a 200 page sleeping pill, if you get my drift.
I will say this, if the plan does cover it, you will absolutely need a prescription slip. Even with this, the company will likely limit you to the amount paid out, don't expect to have insurance pay for a case of Abena X-pluses every week.
If the insurance doesn't cover them, and it is quite likely that it will not since most health insurances are cutting covered things in an effort to curb the rising premiums. The more likely way to cut costs would be to use a Flexible Spending Account.
I'm going to tell you a bit about how they work. What a flexible spending account is, it means that a certain amount of money, you decide how much, is deducted from your paycheck BEFORE taxes. Now, there may be an annual maximum as to how much you can deduct, you should check with your Human Resources person what this amount is. Also, once you elect an amount, you cannot change the amount during the year, there is just a once a year time called "Open Enrollment" when you can make changes. If you use the annual amount during the first 6 months, you still have to pay. If at the end of the year, you did not use all of the money, you will lose it, it will not be refunded to you.
The main benefit of this is that for medical supplies and procedures, the money you spend on it is not taxed. Some companies make you pay up front, and then re-imburse you. Other companies give you a kind of "credit card" that you can use for these purchases, the catch is that you still have to submit receipts. Also, for diapers, the plan that I administer DOES require a doctor's note, but will be covered if the doctor says that there is a medical need. Other's do not, it's up to your plan administrator really.
My insurance company won't cover diapers. However, Medicare does pay for diapers if you're disabled and have a documented health condition. (I'm able to work, so I'm not on that program).
I have not heard back from her yet. She said it would take 1 to 2 days, and I asked her on Friday. I guess I just assumed it wouldn't be covered, I wasn't that concerned about what I was spending, and maybe too embarrassed to ask, but it's amazing how things change when your financial situation becomes a problem. One night recently, I actually figured out what I was spending per month...I couldn't believe it, well over $100 per month!
As for alternatives, cathing was one, surgery was suggested, (ureterostomies) ugh! Condom catheters, (too many skin problems), drugs were tried, and to be honest, I'm really tired of dealing with the doctors, etc.
Anyway, I will post what she said when I hear from her.
My health provider, Kaiser, does not allow payment for diapers, but my flex plan covers them with a doctor's letter describing the medical condition. The flex plan administrator asks every year for an updated letter.
I don't know if my insurance covers diapers or not. I use my Flexible Spending Account money to pay for mine. One interesting thing I noticed when reading the fine print on what you use FSA dollars for is they will let you use your money for diapers, but not for a diaper service. I thought that was kinda odd.
What's the difference between a flex plan and just paying the diapers yourself. How much is deduced from your paycheck to cover those diaper, for example?
Where I live, we don't have to deal with this kind of things. Private and state insurance cover all those things. We only pay the difference if we want better quality.
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