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Thread: Diapers through Insurance

  1. #1

    Default Diapers through Insurance

    I've been trying to get my diapers covered through my Tricare Prime insurance for three months. I first told my military hospital doctor, then had to explain everything to their case manager. A month later I had to talk to my insurance rep, insurance manager, and appeals rep. Another month and I was telling an appeals manager, 2nd level appeals rep, and finally 2nd level appeals manager. The last few were because my disposable diapers were submitted under the code used for disposable underpads. They are not the same thing, stop calling diapers pads people!

    Anyways, we got that straightened out, and I had to start it over again back at my doctors office this morning. I then went right to the case manager and re-explained it all to her, and what and how it all needed to submitted in the right detail. She then also got their distributor involved so we can make sure I'll be able to get them faster. Of course this meant I also spent time talking to the distributor about it all, which included why I'm incontinent, and exactly what kind of diapers I need. (Confidry or Northshore).

    It's looking like I'll be able to get them this time too. Though I still have to go through the waiting game again. Whew though! I've spent the last three months telling more people I need diapers than I have my whole life (internet excluded)!!!

  2. #2

    Default

    Glad to hear it is moving forward - if a bit slow.

    Sometimes I wonder if they spend more money trying to deny the claim and then work through the appeals than they would have spent by just giving the person what they need.

  3. #3

    Default

    Arrrghhh. I hate insurance companies. My doctor said she would write a script for diapers 5 months ago and I put it on hold partly because what you are going through and partly because for years I've paid for premium diapers through my flexible spending account and so I already have a ton of diapers at home. I may end up going this route in the future, but I'm not looking forward to it.

  4. #4
    mikejames

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    I've never tried. I just assume pay for them because from what I've seen online, insurance will only pay for certain brands, generally crappy ones. While I hate the expense of my incontinence, I do have a health savings account that helps a bit, at least making them tax free. I'm used to managing my problem with good products like Abena level 4, Dry 24/7, Northshore,and Seni Quatro and I'd not be ok with dropping down to cheapo diapers just because insurance paid for them. Even relying on high end diapers, it took a lot to get me the confidence to feel like I could be out and about with this condition. I've tried a few cheaper brands and none of them gave me that requisite level of confidence.

  5. #5

    Default

    Yeah, if you're not using FSA or HSA, you're generally going to get what insurance sends you. You don't really have much of a choice.

  6. #6

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    The very best in diapers insurance generally will pay for are ATNS and depending on your level of need will limit your options further as to what is covered and what quantity is available to you. What you get can also be derirmend by what is available ,most HME'S make exclusive "deals" with two manufacturers and you have to shop around to find the most acceptable of the low quality low cost protection , basicly the cheaper the diaper they bill your insurance for the more money that stays in there pocket, I do business with one local HME, serious business my wheelchair alone costs $30,000 but there diaper selection stinks , to even find a place that will attempt to bill for ATNS, I get my diapers shipped from another state via UPS, and it took a rep from PBE and myself making calls two weeks to find this dealer . If cloth is a desired option since you are covered by the VA look to Angelfluff as a supplier , everything they sell execpt some of the babyish stuff is covered by the VA be it diapers , pants ,or onesie. Good luck in finding the "best" of your limited options, my advice is make peace with the cheap ones as a daily "driver" but be prepared to pay out of pocket for something decent to wear away from home, that's the route many of us take to getting a decent level of protection. If I can help in anyway just post or PM me .

    Sent from my SM-T810 using Tapatalk

  7. #7

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    It's fun isn't it? I get diapers from my insurance, but they only supply Prevail brand so I use them as a diaper doubler for M-4's or ABU diapers!


    Sent from my KYOCERA-C6742 using Tapatalk

  8. #8

    Default



    Quote Originally Posted by BabelBilly View Post
    It's fun isn't it? I get diapers from my insurance, but they only supply Prevail brand so I use them as a diaper doubler for M-4's or ABU diapers!


    Sent from my KYOCERA-C6742 using Tapatalk
    Didn't the M4 go Cloth? Or something with them changed, brain fart, because I bought a case right before something changed , been sitting on them they use to be my travel diaper until I found for my specific need the Northshore worked better, have a better "front end" in my opinion. When traveling to out of town doctors I have to wear the same one boosted for like 16 hours because there is nowhere to change. Yeah insurance bean counters have not figured out that better diapers equal less changes which means less expense, and in my situation would translate to whole lot less hassle and wear and tear on the muscles.

    I suppose prevail is better than nothing , but God I hate those things when I tried them I could still walk and almost guaranteed I would need to change my socks because they leaked.
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  9. #9

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    I have officially revealed to my Mom my 25/7 thing!!! Today!
    This is an extremely scary day-i thank God that she lives on the other side of the country!
    Here's the deal: she is my medical power of attorney, payee(i'm disabled mentally due to, in my humble opinion & months and actually years of researching what i consider a "disorder") so i felt it was time to finally time to spill the beans and reveal to her that i've been wearing 24/7 since my Mom IS my medical power of attorney, i BETTER tell before she finds out on her own!
    Hey everyone; this is really happening in real time! I'm 49 in a couple weeks so i feel that i'm finally old enough to actually NEED diapers- in which is the God's honest truth. Yes, i also have in the past needed them: since the first time i wet the bed at age 4 which is so crystal clear in my head that it actually FEELS like yesterday, and now
    currently NEED not want any more...diapers!
    Stay tuned!

    Sent from my KYOCERA-C6742 using Tapatalk

  10. #10

    Default

    So back on topic.

    I just found out my insurance denied my diapers, citing I can get them through the VA instead. Talk about total bs which fully goes against their own bylaws. Of course I will be going through their appeals process once again. Uuugh.

    In the mean time, I guess I should set up an appointment to get re-established with the va. I hear their wait time is finally down to less than a full year too.

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