Need diaper suggestions for cost

I have a prescription from my doctor and an allowance of $1.05 per diaper (max of $162.50/mo)

i was wondering if anyone knew a good absorband diaper for this. my supplier said he can get what i need as long as it follows under this pricing.

You'd have to think differently... How many diapers well you go through each day...

Dry24/7 is $110 for 72 diapers. Ideally, you could use 3-4 per day, depending on much liquids you drink. 30x3.5=105 diapers
30x3=90 diapers
These should easily fit that budget. But it's not $1.05 per diaper. If your insurance covers $162.50, then it would easily be enough per month.

Now the question will become, what kind of protection do you need.

What features do you want?
Cloth back or plastic back?
$162.50 will help you get good supplies.

The cost per diaper doesn't really make sense. You can go and grab Depends for $0.83 per diaper, but actually use 6 diapers per day at a cost of $5.00.
$4.58 @ 3 per day and Dry 24/7 would cost about the same. You would get better protection because of the better features that a premium diaper provides. Less changes, less worrying about leaking, releasable.

There's more options as far as diapers go out there, it's about comparing the overall monthly cost not the per piece price.

Are they stuck on the 1.05 per unit price, or is it the monthly price the true limit, or are they limit on both?

If the limit is just the 162.50 per month then you can go with higher quality higher priced diapers that you won't have to change as much and end up with a cheaper monthly cost. For example you can get a cheap Depends for like $0.85 per unit or Abenas for like $1.30, but when you're changing the Depends 6+ times a day and the Abena only 3 times, you end up with the Depends costing $7.65 per day and the more expensive per unit Abena only costing $3.90 per day.

This is one of the things I hate and try to speak out about when I can, insurance companies have a tendency to only approve the "bare minimum" and with diapers there arise multiple issues with that. First of being that the cheaper per unit diapers usually end up actually costing more per day or per month because they aren't proportionally cheaper to their lesser quality as I showed an example of above. When you're changing twice as much, they will be more expensive in the long run unless they are less than half the price which is not the case with diapers.

Second problem being that certain diapers simply don't work for certain types of incontinence, and this is especially true with the lower end diapers. Depends and other cheap store brands that you find are generally just meant for overflow incontinence, and don't have the capability of reliably handling the floods of urge incontinence, and often are about as good as Fruit of the Loom underwear at stopping fecal incontinence. But the insurance companies don't account for that and just act like "a diaper is a diaper" whereas you need diapers with better wicking for urge incontinence, and for fecal incontinence you need good leaks guards and a lower cut on the buttcheeks. But insurance companies don't account for that so you end up with a bunch of people with urge incontinence suffering by having to use bed pads and chux to soak up the leaks that their diapers not meant for their type of incontinence can't handle because they aren't meant to.

I was checking with my insurance the other day, and they just won't even cover the bare minimum that I need for my fecal incontinence, so my options literally are to pay the cost myself or deal with literal shit all over the place.

I was thinking the same thing as metalmann. Confidry is one of the cheapest diapers out there when looked at on a cost per day or close to $110 per month. And you only have to change 3-4 times each day. Plus with their total capacity you reach near leaking point much less often- meaning fewer leaks overall.

Going with a "cheaper" diaper means you will need to use more diapers per day. Likely double or more, which also doubles their total cost per day. And, with less absorption capability that means you will reach their near leaking point twich as often too- meaning double the leaks.

Seriously, a $1.05 max unit cost will put you in the ATN or Molicare comfort range. At that minimum double the diapers, this will put you close to or over $160 per month, or more.

If you can make this case to your insurance, see if they will be willing to go with the higher unit cost that actually has a lower total cost overall. It would also save you from extra leaks and the need for excessive changes too.

But yeah as Slomo was saying it depends on which costs the insurance is sticking to.

If they are strict on the $1.05 per unit. Tranquility ATN should fit that, and Wellness Superio might fit in there too.

If they only care about the per month limit, then something like a ComfiDry 24/7 would probably be the best bet.

If they are strict on both I'm not even sure there is something that can meet both unless you have really light overflow incontinence.

They said 1.05 per diaper up to 162.50/mo

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ABdei said:

They said 1.05 per diaper up to 162.50/mo

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Right, but there are more caveats with how insurance handles these things. I used to work doing coverage quoting for Blue Cross Blue Shield of Minnesota, it gets a a good deal more complicated than that.

It could mean that the patient can get whatever diaper they want from an approved DME supplier but the insurance company will only pay out at a rate of $1.05 per diaper and only at a maximum of $162.50 per month. But depending on the insurance companies policies it can also mean that they will not pay out whatsoever unless the selected equipment meets the $1.05 & $162.50 rates. A third thing it could mean is that the insurance company is assuming the patient will use 5 diapers a day and have set their diaper payout price for in network providers to $1.05. Different insurance companies have different policies on how payouts are performed. So to properly suggest something for OP it will help us to know how strict the insurance company is to that price and whether it is a "we will pay this portion of the total cost" or "we won't pay at all unless the total cost is within this."

When I worked for BCBSMN I quoted diapers many times, and the quotes would be anywhere from "The plan doesn't cover diapers ever" to "The plan will pay at 80/20 pre-deducitable and 100% post-deductible on whatever you purchase from an in-network DME provider." and various things in between those. It really just depends on their plan.

there are a few factors to consider. can you provide a little more info? male or female, what size, absorbency, etc?

ABdei said:

They said 1.05 per diaper up to 162.50/mo

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I'd ask them back if you can get a clarification and/or waiver to still not exceed the 162.50, but yet be allowed to be over the 1.05. Like I said, make the case that under 1.05 you will need to max out the 162.50, but if over that unit price then you can keep it close to 110. Point out this will obviously save your insurance company about 50 per month. I'm sure they would waive the unit price when hearing that.

The more expensive the diaper the less diapers you use I get dry 24/7s and only need on case a month they sell for 104 dollars at xp medical also NorthShore Supreme or xp medical aplus level 4 are good

question what are your needs? Do you want one you can wear awhile? is it involving bowel issues? These are considerations you need to have

rennecfox said:

question what are your needs? Do you want one you can wear awhile? is it involving bowel issues? These are considerations you need to have

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I wear 24/7 urinary. I prefer p.e. backed. Cloth velcro tapes suck after a while of moving and sag a lot.

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In terms of stuff that would be carried at a place that will bill and be in-network with an insurance company, you're probably going to be looking at either an Abena *4, Northshore Supreme, or Wellness Superio for plastic backed that aren't crap. Tranquility ATN possibly as well, I haven't tried those in a while, but I think they are fairly low capacity.

Hm wonder if a place will cover wellness superio or abena. I've tried tranquility atn before, not bad but a filler at night might be needed

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UPDATE: my vendor will do Abena

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I,

I wear 3 to 4 super seni quatro large from Poland, tested capacity is 4200 mpl at a price of about 63 US cent. I am bladder incontinent only, with occasional fecial incontience you would nedd more diapers.

Kveta

rusalka said:

I,

I wear 3 to 4 super seni quatro large from Poland, tested capacity is 4200 mpl at a price of about 63 US cent. I am bladder incontinent only, with occasional fecial incontience you would nedd more diapers.

Kveta

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Seni are nice but I have issues with the cloth backing style.

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